Provider Demographics
NPI:1124207717
Name:BARRY A. MORGUELAN INC.
Entity Type:Organization
Organization Name:BARRY A. MORGUELAN INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:A
Authorized Official - Last Name:MORGUELAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:213-413-5010
Mailing Address - Street 1:201 S ALVARADO ST
Mailing Address - Street 2:#602
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90057-2355
Mailing Address - Country:US
Mailing Address - Phone:213-413-5010
Mailing Address - Fax:213-413-7734
Practice Address - Street 1:201 S ALVARADO ST
Practice Address - Street 2:#602
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90057-2355
Practice Address - Country:US
Practice Address - Phone:213-413-5010
Practice Address - Fax:213-413-7734
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-30
Last Update Date:2015-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG27009207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G270090Medicaid
CAW7694AMedicare PIN