Provider Demographics
NPI:1689025843
Name:THE SCHOOL-AGED GAP ELIMINATION INITIATIVE, INC
Entity Type:Organization
Organization Name:THE SCHOOL-AGED GAP ELIMINATION INITIATIVE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAVAD
Authorized Official - Middle Name:SAGE
Authorized Official - Last Name:AGHALOO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:760-578-4748
Mailing Address - Street 1:82900 AVENUE 42 STE B103
Mailing Address - Street 2:
Mailing Address - City:INDIO
Mailing Address - State:CA
Mailing Address - Zip Code:92203-9657
Mailing Address - Country:US
Mailing Address - Phone:760-578-4748
Mailing Address - Fax:760-278-2172
Practice Address - Street 1:82900 AVENUE 42 STE B103
Practice Address - Street 2:
Practice Address - City:INDIO
Practice Address - State:CA
Practice Address - Zip Code:92203-9657
Practice Address - Country:US
Practice Address - Phone:760-578-4748
Practice Address - Fax:760-278-2172
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-28
Last Update Date:2019-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental