Provider Demographics
NPI:1457625931
Name:GASTROENTEROLOGY & HEPATOLOGY SPECIALISTS INC
Entity Type:Organization
Organization Name:GASTROENTEROLOGY & HEPATOLOGY SPECIALISTS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MAYUR
Authorized Official - Middle Name:
Authorized Official - Last Name:TRIVEDI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-492-4463
Mailing Address - Street 1:3288 CASINO DR
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91362-4802
Mailing Address - Country:US
Mailing Address - Phone:805-492-4463
Mailing Address - Fax:866-496-4990
Practice Address - Street 1:1687 ERRINGER RD
Practice Address - Street 2:SUITE 103
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93065-6508
Practice Address - Country:US
Practice Address - Phone:805-462-4463
Practice Address - Fax:866-496-4990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-01
Last Update Date:2012-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA91177207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty