Healthcare Provider Details

I. General information

NPI: 1811975832
Provider Name (Legal Business Name): PULMONARY DISEASE CT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2006
Last Update Date: 10/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 W ROMNEYA DR STE 504
ANAHEIM CA
92801-1827
US

IV. Provider business mailing address

1801 W ROMNEYA DR STE 504
ANAHEIM CA
92801-1827
US

V. Phone/Fax

Practice location:
  • Phone: 714-956-3160
  • Fax: 714-956-0341
Mailing address:
  • Phone: 714-956-3160
  • Fax: 714-956-0341

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA25813
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA39683
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA66982
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberA25813
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberA39683
License Number StateCA
# 6
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberA66982
License Number StateCA
# 7
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License NumberA39683
License Number StateCA
# 8
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberA39683
License Number StateCA
# 9
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberA66982
License Number StateCA
# 10
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License NumberA66982
License Number StateCA
# 11
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberA25813
License Number StateCA

VIII. Authorized Official

Name: DR. RAKESH BHOLA
Title or Position: MD
Credential: MD
Phone: 714-956-3160