Provider Demographics
NPI:1558729459
Name:GASTROENTEROLOGY INSTITUTE OF SOUTHERN CALIFORNIA
Entity Type:Organization
Organization Name:GASTROENTEROLOGY INSTITUTE OF SOUTHERN CALIFORNIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PEYTON
Authorized Official - Middle Name:
Authorized Official - Last Name:BEROOKIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-271-1122
Mailing Address - Street 1:PO BOX 67672
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90067-0672
Mailing Address - Country:US
Mailing Address - Phone:310-273-7365
Mailing Address - Fax:310-273-7366
Practice Address - Street 1:150 N ROBERTSON BLVD
Practice Address - Street 2:SUITE 204
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-2142
Practice Address - Country:US
Practice Address - Phone:310-271-1122
Practice Address - Fax:310-271-1126
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-05
Last Update Date:2016-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty