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General NPI Number Information
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NPI Number | 1205033800
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Entity Type | Organization
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Legal Business Name | SOUTHERN CALIFORNIA PULMONARY AND SLEEP DISORDERS MEDICAL CENTER INC.
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Dates
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Enumeration Date | 06/28/2007
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Last Update Date | 08/09/2012
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Provider Practice Location Address
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Address Line | 2230 LYNN RD STE 101
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City | THOUSAND OAKS
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State | CA
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Zip | 91360-1917
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Country | US
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Telephone | 805-557-9930
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Fax | 805-557-9940
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Provider Business Mailing Address
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Address Line | 2230 LYNN RD STE 101
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City | THOUSAND OAKS
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State | CA
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Zip | 91360-1917
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Country | US
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Telephone | 805-557-9930
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Fax | 805-557-9940
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Authorized Official
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Title or Position | OWNER
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Name | DR. RONALD ALAN POPPER
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Credential | M.D. F.C.C.P.
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Telephone | 805-557-9930
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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 | A35734
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License Number State | CA
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