1053593137 NPI number — PULMOCARE RESPIRATORY SERVICES, INC.

Table of content: (NPI 1053593137)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053593137 NPI number — PULMOCARE RESPIRATORY SERVICES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PULMOCARE RESPIRATORY SERVICES, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1053593137
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/20/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 721
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLTON
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92324-0721
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
909-777-5000
Provider Business Mailing Address Fax Number:
909-777-5005

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9353 ACTIVITY RD
Provider Second Line Business Practice Location Address:
SUITE F
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92126-4412
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-547-9100
Provider Business Practice Location Address Fax Number:
909-777-5005
Provider Enumeration Date:
11/30/2007

Additional Information

Authorized Official

Authorized Official Last Name:
GINGLES
Authorized Official First Name:
BRUCE
Authorized Official Middle Name:
E
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
909-777-5000

Provider Taxonomy Codes

  • Taxonomy code: 332BP3500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BX2000X , with the licence number: 100577 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BX2000X , with the licence number: 53198 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: DME02110F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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