Healthcare Provider Details

I. General information

NPI: 1174176648
Provider Name (Legal Business Name): TRANSLATIONAL PULMONARY AND IMMUNOLOGY RESEARCH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2019
Last Update Date: 07/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 E 28TH ST STE 419
LONG BEACH CA
90806-2775
US

IV. Provider business mailing address

701 E 28TH ST STE 419
LONG BEACH CA
90806-2775
US

V. Phone/Fax

Practice location:
  • Phone: 562-490-9900
  • Fax: 562-490-9909
Mailing address:
  • Phone: 562-490-9900
  • Fax: 562-490-9909

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0214X
TaxonomyPediatric Pulmonology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2080P0201X
TaxonomyPediatric Allergy/Immunology Physician
License Number
License Number State

VIII. Authorized Official

Name: SARA KARR
Title or Position: CLINICAL OPERATIONS MANAGER
Credential:
Phone: 562-490-9900