Healthcare Provider Details

I. General information

NPI: 1457456337
Provider Name (Legal Business Name): PEDIATRIC PULMONARY ASSOCIATES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 09/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 ATLANTIC AVE
LONG BEACH CA
90806-1701
US

IV. Provider business mailing address

PO BOX 1307
LONG BEACH CA
90801-1307
US

V. Phone/Fax

Practice location:
  • Phone: 562-933-8740
  • Fax:
Mailing address:
  • Phone: 562-933-8740
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License NumberA33717
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2080P0201X
TaxonomyPediatric Allergy/Immunology Physician
License NumberA33717
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License NumberA33717
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code2080P0214X
TaxonomyPediatric Pulmonology Physician
License NumberA33717
License Number StateCA

VIII. Authorized Official

Name: DR. ELIEZER NUSSBAUM
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 562-933-8740