Provider Demographics
NPI:1225793235
Name:SOUTHERN CALIFORNIA CENTER FOR ADVANCED GYNECOLOGY A MEDICAL CORP
Entity Type:Organization
Organization Name:SOUTHERN CALIFORNIA CENTER FOR ADVANCED GYNECOLOGY A MEDICAL CORP
Other - Org Name:SOUTHERN CALIFORNIA CENTER FOR ADVANCED GYNECOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SALMAN
Authorized Official - Middle Name:N M
Authorized Official - Last Name:OKOUR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-367-3648
Mailing Address - Street 1:3010 BEARD RD
Mailing Address - Street 2:
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94558-3442
Mailing Address - Country:US
Mailing Address - Phone:707-255-8825
Mailing Address - Fax:707-252-9325
Practice Address - Street 1:11100 WARNER AVE STE 116
Practice Address - Street 2:
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-7500
Practice Address - Country:US
Practice Address - Phone:657-356-1281
Practice Address - Fax:310-602-6190
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-04
Last Update Date:2022-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty