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General NPI Number Information
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NPI Number | 1225063340
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Entity Type | Organization
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Legal Business Name | CENTRAL COUNTY CHEST MEDICAL GROUP, INC
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Dates
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Enumeration Date | 07/11/2006
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Last Update Date | 08/13/2010
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Provider Practice Location Address
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Address Line | 11180 WARNER AVE STE 253
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City | FOUNTAIN VALLEY
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State | CA
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Zip | 92708-7515
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Country | US
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Telephone | 714-979-2825
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Fax | 714-979-2862
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Provider Business Mailing Address
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Address Line | 11180 WARNER AVE STE 253
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City | FOUNTAIN VALLEY
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State | CA
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Zip | 92708-7515
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Country | US
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Telephone | 714-979-2825
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Fax | 714-979-2862
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MS. MARY AGUIRRE
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Credential |
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Telephone | 714-979-2825
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0200X
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Taxonomy Name | Critical Care Medicine (Internal Medicine) Physician
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License Number | A43693
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | A43693
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | A42385
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | A42385
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License Number State | CA
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Taxonomy #5
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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