Provider Demographics
NPI:1679733190
Name:PULMONARY CONSULTANTS AND PRIMARY CARE PHYSICIANS MEDICAL GROUP INC
Entity type:Organization
Organization Name:PULMONARY CONSULTANTS AND PRIMARY CARE PHYSICIANS MEDICAL GROUP INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:YONIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-639-9401
Mailing Address - Street 1:1310 W STEWART DR
Mailing Address - Street 2:SUITE 410
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-3854
Mailing Address - Country:US
Mailing Address - Phone:714-639-9401
Mailing Address - Fax:
Practice Address - Street 1:1310 W STEWART DR
Practice Address - Street 2:SUITE 410 PC
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-3854
Practice Address - Country:US
Practice Address - Phone:714-639-9401
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PULMONARY CONSULTANTS & PRIMARY CARE PHYSICIANS MEDICAL GROUP INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-06-10
Last Update Date:2009-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0003350Medicaid
CAGR0003350Medicaid