Provider Demographics
NPI:1811975832
Name:PULMONARY DISEASE CT
Entity type:Organization
Organization Name:PULMONARY DISEASE CT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:RAKESH
Authorized Official - Middle Name:
Authorized Official - Last Name:BHOLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-956-3160
Mailing Address - Street 1:1801 W ROMNEYA DR
Mailing Address - Street 2:STE 504
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92801-1827
Mailing Address - Country:US
Mailing Address - Phone:714-956-3160
Mailing Address - Fax:714-956-0341
Practice Address - Street 1:1801 W ROMNEYA DR
Practice Address - Street 2:STE 504
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801-1827
Practice Address - Country:US
Practice Address - Phone:714-956-3160
Practice Address - Fax:714-956-0341
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PULMONARY DISEASE CT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-01-09
Last Update Date:2008-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA25813207R00000X, 207RC0200X, 207RP1001X
CAA39683207R00000X, 207RC0200X, 207RG0300X, 207RP1001X
CAA66982207R00000X, 207RC0200X, 207RP1001X, 207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Multi-Specialty
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Multi-Specialty
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1811975832OtherMEDICARE NPI
CAGR0021080Medicaid
CAGR0021080Medicaid