Healthcare Provider Details

I. General information

NPI: 1104905199
Provider Name (Legal Business Name): WESTERN PULMONARY MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 01/26/2023
Certification Date: 01/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19742 MACARTHUR BLVD STE 100
IRVINE CA
92612-2408
US

IV. Provider business mailing address

19742 MACARTHUR BLVD STE 100
IRVINE CA
92612-2408
US

V. Phone/Fax

Practice location:
  • Phone: 949-428-0330
  • Fax: 714-879-1049
Mailing address:
  • Phone: 949-428-0330
  • Fax: 714-879-1049

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: JAMES L PEARLE
Title or Position: MD OWNER
Credential: MD
Phone: 714-446-8702