Healthcare Provider Details

I. General information

NPI: 1629511886
Provider Name (Legal Business Name): PRIME PULMONARY & SLEEP MEDICINE CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2016
Last Update Date: 11/12/2024
Certification Date: 11/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8333 BRIMHALL RD BLDG 1000
BAKERSFIELD CA
93312-2243
US

IV. Provider business mailing address

8333 BRIMHALL RD BLDG 1000
BAKERSFIELD CA
93312-2243
US

V. Phone/Fax

Practice location:
  • Phone: 661-695-6777
  • Fax: 661-695-6767
Mailing address:
  • Phone: 661-695-6777
  • Fax: 661-695-6767

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QS1200X
TaxonomySleep Disorder Diagnostic Clinic/Center
License NumberA136724
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code261QS1200X
TaxonomySleep Disorder Diagnostic Clinic/Center
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License NumberA137848
License Number StateCA

VIII. Authorized Official

Name: DR. PRAMIL VAGHASIA
Title or Position: PRESIDENT
Credential: M.D.
Phone: 845-853-6738