Organization
FULLERTON PULMONARY & CRITICAL CARE INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PANAGIOTIS PLATO BOUGAS M.D. (PRESIDENT)
(714) 871-1507
Entity
Organization
Contact information
Practice address
1100 ALTA VISTA DR, FULLERTON, CA 92835-4027
(714) 871-1507
(949) 643-3560
Mailing address
PO BOX 7630, LAGUNA NIGUEL, CA 92607-7630
(949) 643-3345
(949) 643-3560
Taxonomy
Speciality
Code
Description
License number
State
207RP1001X
Pulmonary Disease Physician
Primary
G84424
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G844240
—
CA
01
—
G84424
STATE LICENSE NUMBER
—
Enumeration date
10/31/2007
Last updated
10/31/2007
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