Provider Demographics
NPI:1316276371
Name:SOUTHERN CALIFORNIA ENDOCRINOLOGY, A PROFESSIONAL MEDICAL CORPORATION
Entity type:Organization
Organization Name:SOUTHERN CALIFORNIA ENDOCRINOLOGY, A PROFESSIONAL MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT OF CORPORATION
Authorized Official - Prefix:DR
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:TRISTAN
Authorized Official - Last Name:ALBAY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-480-1382
Mailing Address - Street 1:PO BOX 18675
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92623-8675
Mailing Address - Country:US
Mailing Address - Phone:949-769-3443
Mailing Address - Fax:949-769-3444
Practice Address - Street 1:33 CREEK RD
Practice Address - Street 2:SUITE 130
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92604-4791
Practice Address - Country:US
Practice Address - Phone:949-769-3443
Practice Address - Fax:949-769-3444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-21
Last Update Date:2015-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA94980261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty