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General NPI Number Information
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NPI Number | 1013035864
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Entity Type | Organization
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Legal Business Name | ST. JOSEPH PULMONARY DIAGNOSTIC MEDICAL GROUP
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Dates
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Enumeration Date | 03/27/2007
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Last Update Date | 08/21/2012
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Provider Practice Location Address
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Address Line | 501 S BUENA VISTA ST
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City | BURBANK
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State | CA
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Zip | 91505-4809
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Country | US
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Telephone | 818-972-2626
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Fax | 818-842-5145
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Provider Business Mailing Address
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Address Line | PO BOX 1551
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City | GLENDALE
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State | CA
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Zip | 91209-1551
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Country | US
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Telephone | 818-972-2626
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Fax | 818-842-5145
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. STEVEN TABACK
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Credential | M.D.
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Telephone | 818-972-2626
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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