Healthcare Provider Details

I. General information

NPI: 1033194410
Provider Name (Legal Business Name): PULMONARY MEDICINE ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2005
Last Update Date: 01/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

236 W 6TH ST SUITE 100
RENO NV
89503-4517
US

IV. Provider business mailing address

236 W 6TH ST SUITE 100
RENO NV
89503-4517
US

V. Phone/Fax

Practice location:
  • Phone: 775-329-9010
  • Fax: 775-329-4899
Mailing address:
  • Phone: 775-329-9010
  • Fax: 775-329-4899

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number768833872
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number768833872
License Number StateNV
# 3
Primary TaxonomyN
Taxonomy Code261QS1200X
TaxonomySleep Disorder Diagnostic Clinic/Center
License Number768833872
License Number StateNV

VIII. Authorized Official

Name: DR. DAVID P DE LOS SANTOS
Title or Position: CEO
Credential: MD
Phone: 775-329-9010