Healthcare Provider Details

I. General information

NPI: 1710099049
Provider Name (Legal Business Name): PULMONARY ASSOCIATES MEDICAL GROUP, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 04/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5565 GROSSMONT CENTER DR SUITE 360
LA MESA CA
91942-3020
US

IV. Provider business mailing address

5565 GROSSMONT CENTER DR SUITE 360
LA MESA CA
91942-3020
US

V. Phone/Fax

Practice location:
  • Phone: 619-462-3360
  • Fax: 619-462-3363
Mailing address:
  • Phone: 619-462-3360
  • Fax: 619-462-3363

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal 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: DAVID F. POLSTER
Title or Position: PHYSICIAN/OWNER
Credential: MD
Phone: 619-462-3360