Provider Demographics
NPI:1306482237
Name:B & G MEDICAL AND SURGICAL PROVIDERS A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:B & G MEDICAL AND SURGICAL PROVIDERS A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:ELHAM
Authorized Official - Middle Name:
Authorized Official - Last Name:GADISHAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-490-8181
Mailing Address - Street 1:10660 WILSHIRE BLVD APT 1108
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90024-4526
Mailing Address - Country:US
Mailing Address - Phone:310-490-8181
Mailing Address - Fax:
Practice Address - Street 1:10660 WILSHIRE BLVD APT 1108
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90024-4526
Practice Address - Country:US
Practice Address - Phone:310-490-8181
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-26
Last Update Date:2019-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical