Provider Demographics
NPI:1417008707
Name:OCIGE INC
Entity Type:Organization
Organization Name:OCIGE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR - OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AHMAD
Authorized Official - Middle Name:M
Authorized Official - Last Name:SHABAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-364-2611
Mailing Address - Street 1:26732 CROWN VALLEY PKWY
Mailing Address - Street 2:SUITE 241
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-6306
Mailing Address - Country:US
Mailing Address - Phone:949-364-2611
Mailing Address - Fax:949-364-0226
Practice Address - Street 1:26732 CROWN VALLEY PKWY
Practice Address - Street 2:SUITE 241
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-6306
Practice Address - Country:US
Practice Address - Phone:949-364-2611
Practice Address - Fax:949-364-0226
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-15
Last Update Date:2012-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA060000405261QE0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0800XAmbulatory Health Care FacilitiesClinic/CenterEndoscopy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA060000405OtherDHS STATE LICENSE
CA05D0869549OtherCLIA
CAFNP34251OtherMEDICAL BOARD FICTITIOUS
CAS051149Medicare ID - Type UnspecifiedPROVIDER NUMBER