Provider Demographics
NPI:1093800492
Name:SOUTHERN CALIFORNIA MEDICAL GASTROENTEROLOGY GROUP, INC
Entity Type:Organization
Organization Name:SOUTHERN CALIFORNIA MEDICAL GASTROENTEROLOGY GROUP, INC
Other - Org Name:GASTROENTEROLOGY CENTER OF LOS ANGELES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:F
Authorized Official - Last Name:CORLIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-829-6789
Mailing Address - Street 1:1301 20TH STREET
Mailing Address - Street 2:STE 280
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404
Mailing Address - Country:US
Mailing Address - Phone:310-829-6789
Mailing Address - Fax:310-315-0195
Practice Address - Street 1:351 E TEMPLE ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90012
Practice Address - Country:US
Practice Address - Phone:310-829-6789
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical