Healthcare Provider Details

I. General information

NPI: 1023063492
Provider Name (Legal Business Name): PULMONARY CRITICAL CARE ASSOCIATES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 01/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2925 N SYCAMORE DR SUITE # 306
SIMI VALLEY CA
93065
US

IV. Provider business mailing address

2925 N SYCAMORE DR SUITE # 306
SIMI VALLEY CA
93065
US

V. Phone/Fax

Practice location:
  • Phone: 805-583-4111
  • Fax: 805-583-2041
Mailing address:
  • Phone: 805-583-4111
  • Fax: 805-583-2041

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA43194
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberA43194
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberA43194
License Number StateCA

VIII. Authorized Official

Name: DR. GURDIP SINGH FLORA
Title or Position: OWNER PRESIDENT
Credential: MD
Phone: 805-583-4111