Provider Demographics
NPI:1124770508
Name:SOCAL GASTROENTEROLOGY CORP.
Entity type:Organization
Organization Name:SOCAL GASTROENTEROLOGY CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:OLIVIA
Authorized Official - Middle Name:
Authorized Official - Last Name:JAQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-493-1011
Mailing Address - Street 1:10931 CHERRY ST STE 300
Mailing Address - Street 2:
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720-2496
Mailing Address - Country:US
Mailing Address - Phone:562-493-1011
Mailing Address - Fax:562-594-9226
Practice Address - Street 1:10931 CHERRY ST STE 300
Practice Address - Street 2:
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-2496
Practice Address - Country:US
Practice Address - Phone:562-493-1011
Practice Address - Fax:562-594-9226
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-26
Last Update Date:2022-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty