Provider Demographics
NPI:1225856941
Name:DIGESTIVE HEALTH AND NUTRITION, INC.
Entity type:Organization
Organization Name:DIGESTIVE HEALTH AND NUTRITION, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:KOOROSH
Authorized Official - Middle Name:
Authorized Official - Last Name:KOOROS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-649-1700
Mailing Address - Street 1:6675 ELEGANTE WAY
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92130-5403
Mailing Address - Country:US
Mailing Address - Phone:858-342-8614
Mailing Address - Fax:
Practice Address - Street 1:5222 BALBOA AVE STE 42
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92117-6991
Practice Address - Country:US
Practice Address - Phone:760-649-7100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-01
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0206XAllopathic & Osteopathic PhysiciansPediatricsPediatric GastroenterologyGroup - Single Specialty