Basic Information
| Provider Information | |||||||||
| NPI: | 1922263714 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SAN DIEGO PULMONARY AND CRITICAL CARE MEDICAL GROUP INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4033 3RD AVE STE 300 | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921032138 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6192992570 | ||||||||
| FaxNumber: | 6192942738 | ||||||||
| Practice Location | |||||||||
| Address1: | 4033 3RD AVE STE 300 | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921032138 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6192992570 | ||||||||
| FaxNumber: | 6192942738 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/22/2008 | ||||||||
| LastUpdateDate: | 07/22/2008 | ||||||||
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| AuthorizedOfficialLastName: | LICHTER | ||||||||
| AuthorizedOfficialFirstName: | JULIAN | ||||||||
| AuthorizedOfficialMiddleName: | PHILLIP | ||||||||
| AuthorizedOfficialTitleorPosition: | MEDICAL DOCTOR | ||||||||
| AuthorizedOfficialTelephone: | 6192992570 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0200X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine | 207RS0012X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Sleep Medicine | 207RP1001X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease |
No ID Information.