Provider Demographics
NPI:1821610874
Name:MESA PULMONARY GROUP, INC.
Entity type:Organization
Organization Name:MESA PULMONARY GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:
Authorized Official - Last Name:SWEIDAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-915-4656
Mailing Address - Street 1:P.O. BOX 8500
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92658-8500
Mailing Address - Country:US
Mailing Address - Phone:949-873-5537
Mailing Address - Fax:949-548-2575
Practice Address - Street 1:136 BROADWAY
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92627-2818
Practice Address - Country:US
Practice Address - Phone:949-873-5537
Practice Address - Fax:949-837-5647
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-13
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
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
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1265494835OtherINDIVIDUAL NPI
CA1790181311OtherINDIVIDUAL NPI