1285780692 NPI number — ADVANCED GASTROENTEROLOGY OF MONTEREY COUNTY MEDICAL CORP

Table of content: (NPI 1285780692)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285780692 NPI number — ADVANCED GASTROENTEROLOGY OF MONTEREY COUNTY MEDICAL CORP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADVANCED GASTROENTEROLOGY OF MONTEREY COUNTY MEDICAL CORP
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:
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NPI Number Information

NPI Number:
1285780692
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/14/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
395 DEL MONTE CENTER STE 173
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MONTEREY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93940-6156
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
831-755-6352
Provider Business Mailing Address Fax Number:
831-372-1666

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1441 CONSTITUTION BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SALINAS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93906-3100
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
831-755-6352
Provider Business Practice Location Address Fax Number:
831-755-6297
Provider Enumeration Date:
01/26/2007

Additional Information

Authorized Official

Authorized Official Last Name:
TABBAA
Authorized Official First Name:
MUMTAZ
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
831-755-6352

Provider Taxonomy Codes

  • Taxonomy code: 207RG0100X , with the licence number:  A54688 , 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: 00A546880 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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