Provider Demographics
NPI:1275548158
Name:DIGESTIVE DIAGNOSTIC CENTER INC
Entity Type:Organization
Organization Name:DIGESTIVE DIAGNOSTIC CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROWENA
Authorized Official - Middle Name:
Authorized Official - Last Name:GARCIA-CHUAPOCO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:650-756-5000
Mailing Address - Street 1:1850 SULLIVAN AVE STE 520
Mailing Address - Street 2:
Mailing Address - City:DALY CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94015-2204
Mailing Address - Country:US
Mailing Address - Phone:650-757-7900
Mailing Address - Fax:650-757-1196
Practice Address - Street 1:333 GELLERT BLVD
Practice Address - Street 2:STE 111
Practice Address - City:DALY CITY
Practice Address - State:CA
Practice Address - Zip Code:94015
Practice Address - Country:US
Practice Address - Phone:650-757-7900
Practice Address - Fax:650-757-1196
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-29
Last Update Date:2010-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22D00049D261QE0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0800XAmbulatory Health Care FacilitiesClinic/CenterEndoscopy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASUR01676FMedicaid
CASUR01676FMedicaid
P00151992Medicare PIN