Provider Demographics
NPI:1376083154
Name:ANDREH SARALOU MD INCORPORATED
Entity Type:Organization
Organization Name:ANDREH SARALOU MD INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREH
Authorized Official - Middle Name:
Authorized Official - Last Name:SARALOU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:877-866-7123
Mailing Address - Street 1:6266 AMBER AVE
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93619-9405
Mailing Address - Country:US
Mailing Address - Phone:818-667-8655
Mailing Address - Fax:
Practice Address - Street 1:26147 HATMOR DR
Practice Address - Street 2:
Practice Address - City:CALABASAS
Practice Address - State:CA
Practice Address - Zip Code:91302-1021
Practice Address - Country:US
Practice Address - Phone:818-667-8655
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-28
Last Update Date:2020-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA126581207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA126581OtherLICENSE