Healthcare Provider Details

I. General information

NPI: 1407880719
Provider Name (Legal Business Name): PULMONARY MEDICINE ASSOCIATES MEDICAL GROUP, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 02/01/2022
Certification Date: 02/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 ETHAN WAY SUITE 600
SACRAMENTO CA
95825-2211
US

IV. Provider business mailing address

1300 ETHAN WAY SUITE 600
SACRAMENTO CA
95825-2211
US

V. Phone/Fax

Practice location:
  • Phone: 916-482-7623
  • Fax: 916-679-3563
Mailing address:
  • Phone: 916-482-7623
  • Fax: 916-679-3563

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code2084A2900X
TaxonomyNeurocritical Care Physician
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State

VIII. Authorized Official

Name: STEPHANIE EFSTRATIS
Title or Position: CPC, BUSINESS SERVICES MANAGER
Credential:
Phone: 916-679-3524