1003964370 NPI number — CARE GASTROENTEROLOGY MEDICAL GROUP

Table of content: (NPI 1003964370)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003964370 NPI number — CARE GASTROENTEROLOGY MEDICAL GROUP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CARE GASTROENTEROLOGY MEDICAL GROUP
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1003964370
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/01/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 4517
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MISSION VIEJO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92690-4517
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
949-443-1546
Provider Business Mailing Address Fax Number:
949-443-1077

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
655 CAMINO DE LOS MARES
Provider Second Line Business Practice Location Address:
SUTE 123
Provider Business Practice Location Address City Name:
SAN CLEMENTE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92673-2809
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
949-443-1546
Provider Business Practice Location Address Fax Number:
949-443-1077
Provider Enumeration Date:
01/05/2007

Additional Information

Authorized Official

Authorized Official Last Name:
GUJRAL
Authorized Official First Name:
NAVJYOT
Authorized Official Middle Name:
Authorized Official Title or Position:
PHYSICIAN
Authorized Official Telephone Number:
949-734-4396

Provider Taxonomy Codes

  • Taxonomy code: 207RG0100X , with the licence number:  A60836 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00A608360 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com