Provider Demographics
NPI:1013278670
Name:PULMONARY PARTNERS INC
Entity type:Organization
Organization Name:PULMONARY PARTNERS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:STANLEY
Authorized Official - Last Name:WILDISH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-378-3605
Mailing Address - Street 1:5790 MAGNOLIA AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92506-1874
Mailing Address - Country:US
Mailing Address - Phone:951-368-0427
Mailing Address - Fax:951-368-0429
Practice Address - Street 1:5790 MAGNOLIA AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-1874
Practice Address - Country:US
Practice Address - Phone:951-368-0427
Practice Address - Fax:951-368-0429
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-30
Last Update Date:2012-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG60605207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Single Specialty