Provider Demographics
NPI:1174523831
Name:BARLOW PULMONARY MED GRP INC
Entity type:Organization
Organization Name:BARLOW PULMONARY MED GRP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:S
Authorized Official - Last Name:MELCHOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:213-250-4200
Mailing Address - Street 1:2000 STADIUM WAY
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90026-2606
Mailing Address - Country:US
Mailing Address - Phone:213-250-4200
Mailing Address - Fax:213-250-3274
Practice Address - Street 1:2000 STADIUM WAY
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90026-2606
Practice Address - Country:US
Practice Address - Phone:213-250-4200
Practice Address - Fax:213-250-3274
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAW10197/GR0026170207RP1001X, 261QS1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
Not Answered261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ23809ZOtherOTHER
CAGR0026170Medicaid
CAGR0026170Medicaid