1679754378 NPI number — CENTER FOR ADVANCED PULMONARY MEDICINE

Table of content: (NPI 1679754378)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679754378 NPI number — CENTER FOR ADVANCED PULMONARY MEDICINE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTER FOR ADVANCED PULMONARY MEDICINE
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:
1679754378
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/21/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
18 CORNELL DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RANCHO MIRAGE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92270-3630
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
562-208-2429
Provider Business Mailing Address Fax Number:
760-674-9807

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
71511 HIGHWAY 111
Provider Second Line Business Practice Location Address:
STE J
Provider Business Practice Location Address City Name:
RANCHO MIRAGE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92270-4465
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-674-9800
Provider Business Practice Location Address Fax Number:
760-674-9807
Provider Enumeration Date:
11/21/2007

Additional Information

Authorized Official

Authorized Official Last Name:
GONZALES
Authorized Official First Name:
LEARNED
Authorized Official Middle Name:
R
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
562-208-2429

Provider Taxonomy Codes

  • Taxonomy code: 207RC0200X , with the licence number:  A76930 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RP1001X , with the licence number: A76930 , 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: 00A76930 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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