| Pacific Diagnostics | |
|
13312 Euclid St Garden Grove CA 92843-2514 | |
| (714) 741-0622 | |
| (714) 741-0623 |
| Full Name | Pacific Diagnostics |
|---|---|
| Speciality | Family Medicine |
| Location | 13312 Euclid St, Garden Grove, California |
| Authorized Official Name and Position | Bryn Jarald Henderson (PRESIDENT/OWNER) |
| Authorized Official Contact | 7147410622 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Pacific Diagnostics 17853 Santiago Blvd #107-489 Villa Park CA 92861-4113 Ph: (714) 741-0622 | Pacific Diagnostics 13312 Euclid St Garden Grove CA 92843-2514 Ph: (714) 741-0622 |
| NPI Number | 1306881297 |
|---|---|
| Provider Enumeration Date | 06/17/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1306881297 | NPI | - | NPPES |
| 00AX44011 | Medicaid | CA | |
| 00AX44010 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 20A4401 (California) | Primary |
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