Provider Demographics
NPI:1033423140
Name:PACIFIC PULMONARY GROUP A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:PACIFIC PULMONARY GROUP A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AHMED
Authorized Official - Middle Name:
Authorized Official - Last Name:EL BERSHAWI MD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:440-540-2924
Mailing Address - Street 1:15 MEDICI
Mailing Address - Street 2:
Mailing Address - City:ALISO VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92656-1474
Mailing Address - Country:US
Mailing Address - Phone:520-730-5506
Mailing Address - Fax:440-540-2924
Practice Address - Street 1:15 MEDICI
Practice Address - Street 2:
Practice Address - City:ALISO VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92656-1474
Practice Address - Country:US
Practice Address - Phone:520-730-5506
Practice Address - Fax:440-540-2924
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-30
Last Update Date:2010-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty