Healthcare Provider Details

I. General information

NPI: 1255766523
Provider Name (Legal Business Name): PULMONARY, CRITICAL CARE, & SLEEP SPECIALISTS OF LONG BEACH, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/05/2013
Last Update Date: 09/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23517 SOUTH MAIN STREET SUITE 103
CARSON CA
90745-5234
US

IV. Provider business mailing address

PO BOX 2017
GARDENA CA
90247-0017
US

V. Phone/Fax

Practice location:
  • Phone: 954-850-6404
  • Fax:
Mailing address:
  • Phone: 954-850-6404
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberA37820
License Number StateCA

VIII. Authorized Official

Name: DR. AMJAD MUNIM
Title or Position: PRESIDENT
Credential: MD
Phone: 954-850-6404