MEDICARE: SOUTHERN CALIFORNIA PULMONARY SPECIALIST GROUP

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	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1700313442
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHERN CALIFORNIA PULMONARY SPECIALIST GROUP

Provider Business Mailing Address
First Line	:	4019 BROMPTON AVE
Second Line	:
City	:	BELL
State	:	CA
Zip	:	90201-3419
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4019 BROMPTON AVE
Second Line	:
City	:	BELL
State	:	CA
Zip	:	90201-3419
Country	:	US
Telephone Number	:	323-369-8588
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MOUHAMED FARHAT
Credential	:	MD
Telephone Number	:	323-369-8588

Provider Enumeration Date	:	05/12/2017
Last Update Date	:	05/12/2017

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