Provider Demographics
NPI:1629511886
Name:PRIME PULMONARY & SLEEP MEDICINE CENTER, INC
Entity Type:Organization
Organization Name:PRIME PULMONARY & SLEEP MEDICINE CENTER, INC
Other - Org Name:PRIME PULMONARY & SLEEP MEDICINE CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PRAMIL
Authorized Official - Middle Name:
Authorized Official - Last Name:VAGHASIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:845-853-6738
Mailing Address - Street 1:8305 BRIMHALL RD STE 1601
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93312-2174
Mailing Address - Country:US
Mailing Address - Phone:661-695-6777
Mailing Address - Fax:661-695-6767
Practice Address - Street 1:8305 BRIMHALL RD. #1601
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93312
Practice Address - Country:US
Practice Address - Phone:661-695-6777
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-21
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA137848261QM1300X
CAA136724261QS1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic