Provider Demographics
NPI:1265443303
Name:DIABLO PULMONARY MEDICAL GROUP, INC
Entity type:Organization
Organization Name:DIABLO PULMONARY MEDICAL GROUP, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HIROMI
Authorized Official - Middle Name:C
Authorized Official - Last Name:TAKEKUMA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:925-676-2942
Mailing Address - Street 1:2299 BACON ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94520-2045
Mailing Address - Country:US
Mailing Address - Phone:925-676-2942
Mailing Address - Fax:925-676-7108
Practice Address - Street 1:2299 BACON ST
Practice Address - Street 2:SUITE 2
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94520-2045
Practice Address - Country:US
Practice Address - Phone:925-676-2942
Practice Address - Fax:925-676-7108
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-11
Last Update Date:2013-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0064710Medicaid
CACJ5117OtherRAILROAD MEDICARE
CAGR0064710Medicaid