Western Pacific Med-Corp
Organization Active NPI Methadone Clinic · Mission Viejo, CA
NPI 1386280899 · NPPES record last updated Nov 19, 2019
Key facts
- NPI
- 1386280899
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Methadone Clinic 261QM2800X
- Legal business name
- WESTERN PACIFIC MED-CORP
- Practice address
- 26921 Crown Valley Pkwy Ste 200
Mission Viejo, CA 92691-6501 - Phone
- (818) 956-3737
- Fax
- (818) 543-6767
- NPI assigned
- Nov 19, 2019
- Organization subpart
- No
Authorized official
- Name
- Mr. Jeffery Steven Blake
- Title
- Director of Operations
- Phone
- (818) 956-3737
Other NPIs on the same Medicare enrollment 10
Corporate family (same tax ID) 18
Practitioners 78
-
Shannon P Barney, LVN
-
Rosemarie Charifa, LVN
-
Christine Ciscone, LCSW
-
Julio Cesar Davila, SUDRC
-
Marco Antonio Espinoza, RADT I
-
Raquel Fernandez, LVN
-
Jeremiah Fisher, RADT-I
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 05D2242266 | Western Pacific Med-Corp | Certificate of waiver | Nov 4, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
- Opioid treatment program
- Medicare-enrolled since Jan 1, 2020
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20200214000625 | CA | Part B Supplier - Opioid Treatment Program (Otp) | 5597738443 |
10 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Mission Viejo, CA; Ventura, CA; Van Nuys, CA; Stanton, CA; Reseda, CA; Panorama City, CA; Norwalk, CA; North Hollywood, CA… |
National Provider Directory
- Tax ID family
- Western Pacific Med-Corp
Locations
4544 San Fernando Rd
Ste 201
Glendale, CA 91204
Phone (818) 240-8843
11902 Rosecrans Ave
Ste Ad
Norwalk, CA 90650
Phone (562) 929-7188
7232 Canby Ave
Ste 456
Reseda, CA 91335
Phone (818) 705-5561
14332 Victory Blvd
Van Nuys, CA 91401
Phone (818) 989-1996
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Methadone Clinic | 261QM2800X | Yes |
Addresses
Primary practice location
26921 Crown Valley Pkwy Ste 200
Mission Viejo, CA 92691-6501
Mailing address
4544 San Fernando Rd Ste 202
Glendale, CA 91204-5015
Phone (818) 956-3737
Other providers in Mission Viejo, CA
- Wesley Y Kim M.D., Inc.
- West Coast Optometric Group
- Linda L. West
- Gary R Westad
- Western Anesthesia Medical Associates Inc
- Western Youth Services
- Jennifer Lynn Wheeler
- Iyanna White
- Keira Deanna White
- Kristi Alexandra White
All providers in Mission Viejo, CA · Methadone Clinic in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 19, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.