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General NPI Number Information
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NPI Number | 1568689966
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Entity Type | Organization
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Legal Business Name | VALLEY PULMONARY MEDICAL GROUP
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Dates
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Enumeration Date | 04/19/2007
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Last Update Date | 05/25/2012
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Provider Practice Location Address
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Address Line | 18546 ROSCOE BLVD STE 308
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City | NORTHRIDGE
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State | CA
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Zip | 91324-4669
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Country | US
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Telephone | 818-349-2931
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Fax | 818-349-7930
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Provider Business Mailing Address
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Address Line | 18546 ROSCOE BLVD STE 308
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City | NORTHRIDGE
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State | CA
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Zip | 91324-4669
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Country | US
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Telephone | 818-349-2931
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Fax | 818-349-7930
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Authorized Official
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Title or Position | OWNER
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Name | DR. JEAN GRANT HAWKINS
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Credential | MD
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Telephone | 818-349-2931
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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 | G43200
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License Number State | CA
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