Provider Demographics
NPI:1205033800
Name:SOUTHERN CALIFORNIA PULMONARY AND SLEEP DISORDERS MEDICAL CENTER INC.
Entity Type:Organization
Organization Name:SOUTHERN CALIFORNIA PULMONARY AND SLEEP DISORDERS MEDICAL CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:POPPER
Authorized Official - Suffix:
Authorized Official - Credentials:MD FCCP
Authorized Official - Phone:805-557-9930
Mailing Address - Street 1:2230 LYNN RD STE 101
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91360-1917
Mailing Address - Country:US
Mailing Address - Phone:805-557-9930
Mailing Address - Fax:805-557-9940
Practice Address - Street 1:2230 LYNN RD STE 101
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360-1917
Practice Address - Country:US
Practice Address - Phone:805-557-9930
Practice Address - Fax:805-557-9940
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-28
Last Update Date:2012-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA35734174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA84805Medicare UPIN
CAW14817Medicare ID - Type Unspecified