Provider Demographics
NPI:1700313442
Name:SOUTHERN CALIFORNIA PULMONARY SPECIALIST GROUP
Entity Type:Organization
Organization Name:SOUTHERN CALIFORNIA PULMONARY SPECIALIST GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MOUHAMED
Authorized Official - Middle Name:
Authorized Official - Last Name:FARHAT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:323-369-8588
Mailing Address - Street 1:4019 BROMPTON AVE
Mailing Address - Street 2:
Mailing Address - City:BELL
Mailing Address - State:CA
Mailing Address - Zip Code:90201-3419
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4019 BROMPTON AVE
Practice Address - Street 2:
Practice Address - City:BELL
Practice Address - State:CA
Practice Address - Zip Code:90201-3419
Practice Address - Country:US
Practice Address - Phone:323-369-8588
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-12
Last Update Date:2017-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty