Healthcare Provider Details

I. General information

NPI: 1447410519
Provider Name (Legal Business Name): PULMONARY CONSULTANTS AND PRIMARY CARE PHYSICIANS MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2008
Last Update Date: 06/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 W LA VETA AVE SUITE 750
ORANGE CA
92868-4304
US

IV. Provider business mailing address

1010 W LA VETA AVE SUITE 750
ORANGE CA
92868-4312
US

V. Phone/Fax

Practice location:
  • Phone: 714-361-6600
  • Fax:
Mailing address:
  • Phone: 714-361-6600
  • Fax: 714-919-8804

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JACK STEWART
Title or Position: PRESIDENT - AUTHORIZED OFFICIAL
Credential: MD
Phone: 714-639-9401