Provider Demographics
NPI:1477646313
Name:PULMONARY DIAGNOSTIC & REHABILITATION MEDICAL GROUP, INC.
Entity Type:Organization
Organization Name:PULMONARY DIAGNOSTIC & REHABILITATION MEDICAL GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:P L
Authorized Official - Last Name:SACHS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:650-833-7994
Mailing Address - Street 1:PO BOX 60249
Mailing Address - Street 2:
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94306-0249
Mailing Address - Country:US
Mailing Address - Phone:650-494-1495
Mailing Address - Fax:650-494-8117
Practice Address - Street 1:145 N CALIFORNIA AVE
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94301-3965
Practice Address - Country:US
Practice Address - Phone:650-833-7994
Practice Address - Fax:650-833-7990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2013-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG25547207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA42704Medicare UPIN
CAZZZ14217ZMedicare ID - Type Unspecified