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General NPI Number Information
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NPI Number | 1336868215
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Entity Type | Organization
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Legal Business Name | AMERICAN CRITICAL CARE CONSULTANTS CORPORATION
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Dates
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Enumeration Date | 08/24/2022
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Last Update Date | 01/24/2025
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Provider Practice Location Address
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Address Line | 4081 E OLYMPIC BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90023-3330
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Country | US
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Telephone | 323-267-0477
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Fax |
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Provider Business Mailing Address
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Address Line | 3579 E FOOTHILL BLVD STE 432
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City | PASADENA
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State | CA
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Zip | 91107-3119
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | VIMAL J PONNEZHAN
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Credential | MD
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Telephone | 310-422-3000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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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 |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207RG0300X
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Taxonomy Name | Geriatric Medicine (Internal Medicine) Physician
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License Number |
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License Number State |
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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 |
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License Number State |
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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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