Provider Demographics
NPI:1376043596
Name:CLINIC OF PULMONARY SLEEP AND HEALTHY AGING, P.A.
Entity Type:Organization
Organization Name:CLINIC OF PULMONARY SLEEP AND HEALTHY AGING, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GUSTAVO
Authorized Official - Middle Name:
Authorized Official - Last Name:FERREIRA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:830-480-5133
Mailing Address - Street 1:PO BOX 1051
Mailing Address - Street 2:
Mailing Address - City:PLEASANTON
Mailing Address - State:TX
Mailing Address - Zip Code:78064-1041
Mailing Address - Country:US
Mailing Address - Phone:830-480-5133
Mailing Address - Fax:830-480-5144
Practice Address - Street 1:220 W GOODWIN ST STE B
Practice Address - Street 2:
Practice Address - City:PLEASANTON
Practice Address - State:TX
Practice Address - Zip Code:78064-4119
Practice Address - Country:US
Practice Address - Phone:830-480-5133
Practice Address - Fax:830-480-5144
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-14
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK9525207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00Q89HOtherBCBS