Provider Demographics
NPI:1992935704
Name:WEST GASTROENTEROLOGY MEDICAL GROUP
Entity type:Organization
Organization Name:WEST GASTROENTEROLOGY MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ADEBAMBO
Authorized Official - Middle Name:O
Authorized Official - Last Name:OJURI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-674-0144
Mailing Address - Street 1:8110 AIRPORT BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-3119
Mailing Address - Country:US
Mailing Address - Phone:310-674-0144
Mailing Address - Fax:
Practice Address - Street 1:8110 AIRPORT BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90045-3119
Practice Address - Country:US
Practice Address - Phone:310-674-0144
Practice Address - Fax:310-674-1704
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WEST GASTROENTEROLOGY MEDICAL GROUP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-07-15
Last Update Date:2012-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA46336174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA8052141514OtherTEL. NUMBER