Provider Demographics
NPI:1679228316
Name:PACIFIC DIAGNOSTICS, INC.
Entity type:Organization
Organization Name:PACIFIC DIAGNOSTICS, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:ALEXANDRE
Authorized Official - Middle Name:
Authorized Official - Last Name:BAGDASSARIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:858-524-6199
Mailing Address - Street 1:15725 POMERADO RD STE 108
Mailing Address - Street 2:
Mailing Address - City:POWAY
Mailing Address - State:CA
Mailing Address - Zip Code:92064-2058
Mailing Address - Country:US
Mailing Address - Phone:858-524-6199
Mailing Address - Fax:619-732-5555
Practice Address - Street 1:15725 POMERADO RD STE 108
Practice Address - Street 2:
Practice Address - City:POWAY
Practice Address - State:CA
Practice Address - Zip Code:92064-2058
Practice Address - Country:US
Practice Address - Phone:858-524-6199
Practice Address - Fax:619-732-5555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-21
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHY60057OtherBOARD OF PHARMACY