Provider Demographics
NPI:1720247455
Name:PULMONARY CONSULTANTS AND PRIMARY CARE PHYSICIANS MEDICAL GROUP, INC.
Entity Type:Organization
Organization Name:PULMONARY CONSULTANTS AND PRIMARY CARE PHYSICIANS MEDICAL GROUP, INC.
Other - Org Name:TUSTIN OFFICE
Other - Org Type:Other Name
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:YONIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-639-9401
Mailing Address - Street 1:1310 W STEWART DR
Mailing Address - Street 2:SUITE 410
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-3854
Mailing Address - Country:US
Mailing Address - Phone:714-639-9401
Mailing Address - Fax:
Practice Address - Street 1:18102 IRVINE BLVD
Practice Address - Street 2:SUITE 105
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-3402
Practice Address - Country:US
Practice Address - Phone:714-832-0510
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-06
Last Update Date:2009-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0003350Medicaid
CAW1514BMedicare PIN