Healthcare Provider Details

I. General information

NPI: 1720247455
Provider Name (Legal Business Name): PULMONARY CONSULTANTS AND PRIMARY CARE PHYSICIANS MEDICAL GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2008
Last Update Date: 03/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18102 IRVINE BLVD SUITE 105
TUSTIN CA
92780-3402
US

IV. Provider business mailing address

1310 W STEWART DR SUITE 410
ORANGE CA
92868-3854
US

V. Phone/Fax

Practice location:
  • Phone: 714-832-0510
  • Fax:
Mailing address:
  • Phone: 714-639-9401
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER YONIS
Title or Position: OPERATIONS MANAGER
Credential:
Phone: 714-639-9401