Provider Demographics
NPI:1497755011
Name:SOUTHWEST PULMONARY MEDICAL GROUP A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:SOUTHWEST PULMONARY MEDICAL GROUP A MEDICAL CORPORATION
Other - Org Name:SOUTHBAY PULMONARY MEDICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:ANTONIO
Authorized Official - Last Name:LIRA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:619-482-7301
Mailing Address - Street 1:841 KUHN DR, SUITE 200
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91914-4523
Mailing Address - Country:US
Mailing Address - Phone:619-482-7301
Mailing Address - Fax:619-482-7302
Practice Address - Street 1:841 KUHN DR, SUITE 200
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91914-4523
Practice Address - Country:US
Practice Address - Phone:619-482-7301
Practice Address - Fax:619-482-7302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-26
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA33913207RP1001X, 207RP1001X
CA20A11042207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A339130Medicaid
CA00A485510Medicaid
CAA27297Medicare UPIN
CAWA48551AMedicare ID - Type Unspecified
CAE52093Medicare UPIN
CAWA33913CMedicare ID - Type Unspecified