MEDICARE: PULMONARY DISEASE SERVICES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QC1500X	Community Health Clinic/Center	546892	CA

General Provider Information

NPI Number	:	1104905629
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PULMONARY DISEASE SERVICES

Provider Business Mailing Address
First Line	:	14301 MARINER LN
Second Line	:
City	:	WESTMINSTER
State	:	CA
Zip	:	92683-4573
Country	:	US
Telephone Number	:	714-896-7382
Fax Number	:	714-896-7316

Provider Business Practice Location Address
First Line	:	14120 BEACH BLVD STE 104
Second Line	:
City	:	WESTMINSTER
State	:	CA
Zip	:	92683-4454
Country	:	US
Telephone Number	:	714-896-7382
Fax Number	:	714-896-7316

Authorized Official
Title or Position	:	PUBLIC HEALTH NURSE
Name	:	MRS. LYNN TRAN
Credential	:	REGISTERED NURSE
Telephone Number	:	714-896-7382

Provider Enumeration Date	:	11/03/2006
Last Update Date	:	07/11/2007

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