Provider Demographics
NPI:1487656864
Name:VALLEY GASTROENTEROLGY CONSULTANTS MEDICAL CENTER, INC.
Entity Type:Organization
Organization Name:VALLEY GASTROENTEROLGY CONSULTANTS MEDICAL CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MOURANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-592-6157
Mailing Address - Street 1:488 E SANTA CLARA ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91006-7229
Mailing Address - Country:US
Mailing Address - Phone:909-592-6157
Mailing Address - Fax:909-592-1544
Practice Address - Street 1:1330 W COVINA BLVD
Practice Address - Street 2:SUITE 203
Practice Address - City:SAN DIMAS
Practice Address - State:CA
Practice Address - Zip Code:91773-3200
Practice Address - Country:US
Practice Address - Phone:909-592-6157
Practice Address - Fax:909-592-1544
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty