Healthcare Provider Details

I. General information

NPI: 1437566882
Provider Name (Legal Business Name): PACIFIC PULMONARY CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2014
Last Update Date: 03/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3638 UNIVERSITY AVE SUITE.221
RIVERSIDE CA
92501-3331
US

IV. Provider business mailing address

3638 UNIVERSITY AVE SUITE.221
RIVERSIDE CA
92501-3331
US

V. Phone/Fax

Practice location:
  • Phone: 951-880-1044
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2279P1005X
TaxonomyPulmonary Rehabilitation Registered Respiratory Therapist
License Number
License Number StateCA

VIII. Authorized Official

Name: MARTIN SILVA
Title or Position: OWNER
Credential:
Phone: 951-880-1044