Provider Demographics
NPI:1528953882
Name:SOUTHERN CALIFORNIA FATTY LIVER CENTER INC
Entity type:Organization
Organization Name:SOUTHERN CALIFORNIA FATTY LIVER CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:RENE
Authorized Official - Middle Name:
Authorized Official - Last Name:RAMIREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-581-0509
Mailing Address - Street 1:131 ORANGE AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:CORONADO
Mailing Address - State:CA
Mailing Address - Zip Code:92118-1408
Mailing Address - Country:US
Mailing Address - Phone:619-377-8391
Mailing Address - Fax:
Practice Address - Street 1:2436 FENTON ST # 100
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91914-3516
Practice Address - Country:US
Practice Address - Phone:619-377-8391
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-09
Last Update Date:2025-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty