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General NPI Number Information
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NPI Number | 1821610874
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Entity Type | Organization
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Legal Business Name | MESA PULMONARY GROUP, INC.
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Dates
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Enumeration Date | 05/13/2020
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Last Update Date | 10/09/2024
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Provider Practice Location Address
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Address Line | 136 BROADWAY
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City | COSTA MESA
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State | CA
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Zip | 92627-2818
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Country | US
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Telephone | 949-873-5537
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Fax | 949-837-5647
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Provider Business Mailing Address
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Address Line | P.O. BOX 8500
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City | NEWPORT BEACH
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State | CA
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Zip | 92658-8500
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Country | US
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Telephone | 949-873-5537
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Fax | 949-548-2575
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Authorized Official
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Title or Position | PRESIDENT/CEO/OWNER
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Name | JACOB SWEIDAN
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Credential | M.D.
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Telephone | 714-915-4656
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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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 | 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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