1942328273 NPI number — CITRUS VALLEY GASTROENTEROLOGY A MEDICAL CORPORATION

Table of content: (NPI 1942328273)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942328273 NPI number — CITRUS VALLEY GASTROENTEROLOGY A MEDICAL CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CITRUS VALLEY GASTROENTEROLOGY A MEDICAL CORPORATION
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:
6
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:
1942328273
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/07/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
415 W ROUTE 66
Provider Second Line Business Mailing Address:
# 102
Provider Business Mailing Address City Name:
GLENDORA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91740-4335
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
626-610-2112
Provider Business Mailing Address Fax Number:
626-610-2119

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
415 W ROUTE 66
Provider Second Line Business Practice Location Address:
# 102
Provider Business Practice Location Address City Name:
GLENDORA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91740-4335
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
626-610-2112
Provider Business Practice Location Address Fax Number:
626-610-2119
Provider Enumeration Date:
03/26/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ARORA
Authorized Official First Name:
SARTAJ
Authorized Official Middle Name:
M
Authorized Official Title or Position:
MD
Authorized Official Telephone Number:
626-737-1066

Provider Taxonomy Codes

  • Taxonomy code: 207RG0100X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1942328273 . This is a "NPI" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com