Provider Demographics
NPI:1528438876
Name:SOUTHERN CALIFORNIA GASTROENTEROLOY & HEPATOLOGY
Entity type:Organization
Organization Name:SOUTHERN CALIFORNIA GASTROENTEROLOY & HEPATOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:O5167616WNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TAHMINA
Authorized Official - Middle Name:SULTANA
Authorized Official - Last Name:HAQ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-487-7468
Mailing Address - Street 1:910 S SUNSET AVE
Mailing Address - Street 2:SUITE 5
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91790-3409
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:910 S SUNSET AVE
Practice Address - Street 2:SUITE 5
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91790-3409
Practice Address - Country:US
Practice Address - Phone:310-487-7468
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-29
Last Update Date:2015-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA116126261Q00000X, 261QA1903X, 261QE0800X, 282E00000X, 282N00000X
261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
No261QE0800XAmbulatory Health Care FacilitiesClinic/CenterEndoscopy
No282E00000XHospitalsLong Term Care Hospital
No282N00000XHospitalsGeneral Acute Care Hospital