Provider Demographics
NPI:1902927882
Name:S. MOURANI & E. TARAKJI MEDICAL PARTNERSHIP
Entity Type:Organization
Organization Name:S. MOURANI & E. TARAKJI MEDICAL PARTNERSHIP
Other - Org Name:VALLEY GI CONSULTANTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARTNERS
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MOURANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-359-3330
Mailing Address - Street 1:488 E SANTA CLARA ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91006-7231
Mailing Address - Country:US
Mailing Address - Phone:626-359-3330
Mailing Address - Fax:626-359-3339
Practice Address - Street 1:415 W CARROLL AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:GLENDORA
Practice Address - State:CA
Practice Address - Zip Code:91741-4208
Practice Address - Country:US
Practice Address - Phone:626-963-2490
Practice Address - Fax:626-963-2495
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2010-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0090110Medicaid
CAGR0090110Medicaid