Provider Demographics
NPI:1356431043
Name:DIGESTIVE HEALTH CONSLTS MEDICAL GROUP INC.
Entity type:Organization
Organization Name:DIGESTIVE HEALTH CONSLTS MEDICAL GROUP INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:M
Authorized Official - Last Name:BURNS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-845-3773
Mailing Address - Street 1:201 SOUTH BUENA VISTA STREET
Mailing Address - Street 2:#410
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91505-4406
Mailing Address - Country:US
Mailing Address - Phone:818-845-3773
Mailing Address - Fax:818-845-4211
Practice Address - Street 1:201 S BUENA VISTA ST STE 410
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91505-4571
Practice Address - Country:US
Practice Address - Phone:818-845-3773
Practice Address - Fax:818-845-0788
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ52970ZOtherBLUE CROSS BLUE SHIELD
CAGR0071620OtherMEDICAL
W11426Medicare ID - Type Unspecified