Provider Demographics
NPI:1205853041
Name:EUCLID ENDOSCOPY CENTER, LP
Entity Type:Organization
Organization Name:EUCLID ENDOSCOPY CENTER, LP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TADDESE
Authorized Official - Middle Name:T
Authorized Official - Last Name:DESTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:619-266-3332
Mailing Address - Street 1:286 EUCLID AVE STE 109
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92114-3611
Mailing Address - Country:US
Mailing Address - Phone:619-266-3332
Mailing Address - Fax:619-266-6006
Practice Address - Street 1:286 EUCLID AVE STE 109
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92114-3611
Practice Address - Country:US
Practice Address - Phone:619-266-3332
Practice Address - Fax:619-266-6006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPENDING261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical