Healthcare Provider Details

I. General information

NPI: 1053649293
Provider Name (Legal Business Name): PRECISION CARDIO PULMONARY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2009
Last Update Date: 11/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1104 CORPORATE WAY SUITE 221
SACRAMENTO CA
95831-3875
US

IV. Provider business mailing address

2194 MAIN ST SUITE I
DUNEDIN FL
34698-5696
US

V. Phone/Fax

Practice location:
  • Phone: 866-961-5589
  • Fax: 866-961-5586
Mailing address:
  • Phone: 866-961-5589
  • Fax: 866-961-5586

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MRS. KIMBERLY A JOHNS
Title or Position: SOLE MBR
Credential: CRT
Phone: 866-961-5589