Basic Information
| Provider Information | |||||||||
| NPI: | 1730355801 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FULLERTON CHEST AND CRTITICAL CARE INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1038 E BASTANCHURY RD | ||||||||
| Address2: | SUITE 206 | ||||||||
| City: | FULLERTON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928352786 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7144477303 | ||||||||
| FaxNumber: | 7149969267 | ||||||||
| Practice Location | |||||||||
| Address1: | 1038 E BASTANCHURY RD | ||||||||
| Address2: | SUITE 206 | ||||||||
| City: | FULLERTON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928352786 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7144477303 | ||||||||
| FaxNumber: | 7149969267 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/07/2008 | ||||||||
| LastUpdateDate: | 05/07/2008 | ||||||||
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| AuthorizedOfficialLastName: | KHABAZ | ||||||||
| AuthorizedOfficialFirstName: | FARHAN | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT OWNER | ||||||||
| AuthorizedOfficialTelephone: | 7144477303 | ||||||||
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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 | A69690 | CA | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine | 207RP1001X | A69690 | CA | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease |
ID Information
| ID | Type | State | Issuer | Description | 1427159458 | 01 | CA | INDIVIDUAL NPI | OTHER |