Provider Demographics
NPI:1053683953
Name:SOUTHERN CALIFORNIA HOSPITALIST GROUP
Entity Type:Organization
Organization Name:SOUTHERN CALIFORNIA HOSPITALIST GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR/CEO/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALIDAD
Authorized Official - Middle Name:M
Authorized Official - Last Name:ZADEH
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:909-527-3651
Mailing Address - Street 1:5457 TURQUOISE AVE
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91701-1227
Mailing Address - Country:US
Mailing Address - Phone:909-527-3651
Mailing Address - Fax:
Practice Address - Street 1:5457 TURQUOISE AVE
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91701-1227
Practice Address - Country:US
Practice Address - Phone:909-527-3651
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-08
Last Update Date:2012-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A10575282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital