Provider Demographics
NPI:1932149283
Name:SAN JOAQUIN VALLEY PULMONARY GROUP
Entity Type:Organization
Organization Name:SAN JOAQUIN VALLEY PULMONARY GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MO
Authorized Official - Middle Name:
Authorized Official - Last Name:ZAHIRUDDIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:661-327-3743
Mailing Address - Street 1:5801 TRUXTUN AVE
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93309-0609
Mailing Address - Country:US
Mailing Address - Phone:661-327-3747
Mailing Address - Fax:661-616-3237
Practice Address - Street 1:5801 TRUXTUN AVE
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93309-0609
Practice Address - Country:US
Practice Address - Phone:661-327-3747
Practice Address - Fax:661-616-3237
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-07
Last Update Date:2021-08-03
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
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Multi-Specialty
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Multi-Specialty
No208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ15299ZOtherMEDICARE PTAN