Provider Demographics
NPI:1811042906
Name:PREMIERE PULMONARY CONSULTANTS A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:PREMIERE PULMONARY CONSULTANTS A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DOTTIE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:SAZON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:619-470-6195
Mailing Address - Street 1:502 EUCLID AVE
Mailing Address - Street 2:SUITE 304
Mailing Address - City:NATIONAL CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91950-2931
Mailing Address - Country:US
Mailing Address - Phone:619-470-6195
Mailing Address - Fax:619-470-6199
Practice Address - Street 1:502 EUCLID AVE
Practice Address - Street 2:SUITE 304
Practice Address - City:NATIONAL CITY
Practice Address - State:CA
Practice Address - Zip Code:91950-2931
Practice Address - Country:US
Practice Address - Phone:619-470-6195
Practice Address - Fax:619-470-6199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA48932207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Multi-Specialty
Not Answered207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW14435AMedicare ID - Type UnspecifiedMEDICARE PROVIDER #