Healthcare Provider Details

I. General information

NPI: 1013278670
Provider Name (Legal Business Name): PULMONARY PARTNERS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2012
Last Update Date: 05/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5790 MAGNOLIA AVE SUITE 201
RIVERSIDE CA
92506-1874
US

IV. Provider business mailing address

5790 MAGNOLIA AVE SUITE 201
RIVERSIDE CA
92506-1874
US

V. Phone/Fax

Practice location:
  • Phone: 951-368-0427
  • Fax: 951-368-0429
Mailing address:
  • Phone: 951-368-0427
  • Fax: 951-368-0429

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License NumberG60605
License Number StateCA

VIII. Authorized Official

Name: MR. STEVEN STANLEY WILDISH
Title or Position: MANAGER
Credential:
Phone: 951-378-3605