Provider Demographics
NPI:1568551968
Name:WEST VALLEY PULMONARY MEDICAL GROUP
Entity Type:Organization
Organization Name:WEST VALLEY PULMONARY MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:
Authorized Official - Last Name:HAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-716-6446
Mailing Address - Street 1:7320 WOODLAKE AVE
Mailing Address - Street 2:SUITE # 290
Mailing Address - City:WEST HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91307-1468
Mailing Address - Country:US
Mailing Address - Phone:818-716-6446
Mailing Address - Fax:818-716-9869
Practice Address - Street 1:7320 WOODLAKE AVE
Practice Address - Street 2:SUITE # 290
Practice Address - City:WEST HILLS
Practice Address - State:CA
Practice Address - Zip Code:91307-1468
Practice Address - Country:US
Practice Address - Phone:818-716-6446
Practice Address - Fax:818-716-9869
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2008-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0022620Medicaid
CAW5575AMedicare PIN