MEDICARE: PULMOCARE RESPIRATORY SERVICES, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332BP3500X	Parenteral & Enteral Nutrition Supplies (DME)
2	332BX2000X	Oxygen Equipment & Supplies (DME)	100577	CA
3	332BX2000X	Oxygen Equipment & Supplies (DME)	53198	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053593137
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PULMOCARE RESPIRATORY SERVICES, INC.

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

Provider Business Practice Location Address
First Line	:	9353 ACTIVITY RD
Second Line	:	SUITE F
City	:	SAN DIEGO
State	:	CA
Zip	:	92126-4412
Country	:	US
Telephone Number	:	858-547-9100
Fax Number	:	909-777-5005

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	MR. BRUCE E GINGLES
Credential	:
Telephone Number	:	909-777-5000

Provider Enumeration Date	:	11/30/2007
Last Update Date	:	09/20/2012

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Directions to “PULMOCARE RESPIRATORY SERVICES, INC. ” Practice Location

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