Provider Demographics
NPI:1629874847
Name:PACIFICO ENTERPRISE LLC
Entity type:Organization
Organization Name:PACIFICO ENTERPRISE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:NIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MASEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:251-388-9055
Mailing Address - Street 1:30 SCHILLINGER RD N STE 102
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36608-5060
Mailing Address - Country:US
Mailing Address - Phone:251-388-9055
Mailing Address - Fax:
Practice Address - Street 1:30 SCHILLINGER RD N STE 102
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36608-5060
Practice Address - Country:US
Practice Address - Phone:251-388-9055
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-19
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246XS1301XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist CardiovascularSonographyGroup - Multi-Specialty
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier