Provider Demographics
NPI:1740211978
Name:CMC PULMONARY PHYSIOLOGY LABORATORY
Entity Type:Organization
Organization Name:CMC PULMONARY PHYSIOLOGY LABORATORY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:K
Authorized Official - Last Name:ROTHBART
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:213-742-0910
Mailing Address - Street 1:2300 S FLOWER ST
Mailing Address - Street 2:#101
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90007-2660
Mailing Address - Country:US
Mailing Address - Phone:213-742-0910
Mailing Address - Fax:213-742-6631
Practice Address - Street 1:1401 S GRAND AVE
Practice Address - Street 2:CARDIOPULMONARY DEPARTMENT
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90015-3010
Practice Address - Country:US
Practice Address - Phone:213-742-0910
Practice Address - Fax:213-742-6631
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0056190Medicaid
CAHW12091Medicare ID - Type UnspecifiedMEDICARE PROV. NO.