Pacifica Medical Supply

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

License

2756954 Issued in CA

Legal business name

PACIFICA MEDICAL SUPPLY

Practice address

24192 Mimosa Dr
Laguna Beach, CA 92677-7000

Phone

(949) 677-7523

NPI assigned

Sep 25, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Kevin Polucha

Title

Owner

Phone

(949) 677-7523

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1190678400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1190678400000",
    "number": "1164619987",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "24192 MIMOSA DR",
            "city": "LAGUNA BEACH",
            "state": "CA",
            "postal_code": "926777000",
            "telephone_number": "949-677-7523"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24192 MIMOSA DR",
            "city": "LAGUNA BEACH",
            "state": "CA",
            "postal_code": "926777000",
            "telephone_number": "949-677-7523"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PACIFICA MEDICAL SUPPLY",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-25",
        "last_updated": "2007-09-25",
        "status": "A",
        "authorized_official_last_name": "POLUCHA",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "949-677-7523"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "CA",
            "license": "2756954",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Optometry of Laguna Beach
• Orange Coast Head and Neck Surgery
• Yesenia Ortega
• Kay Wickett Ostensen, PHD
• Pacific Coast Naturopathic Health
• Theron Dean Page Jr.
• David S Palmer, PH.D.
• Fabrice Paracuellos, MFT
• Charles Michael Parise, M.D.
• Christine Hyunsun Park, MD

• Durable Medical Equipment & Medical Supplies in Laguna Beach, CA
• Providers in Laguna Beach, CA by specialty
• Durable Medical Equipment & Medical Supplies in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.