Provider Demographics
NPI:1871633099
Name:SOUTHERN CALIFORNIA LIVER CENTERS INC
Entity Type:Organization
Organization Name:SOUTHERN CALIFORNIA LIVER CENTERS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:PROF
Authorized Official - First Name:TAREK
Authorized Official - Middle Name:
Authorized Official - Last Name:HASSANEIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:619-964-9649
Mailing Address - Street 1:PO BOX 181770
Mailing Address - Street 2:
Mailing Address - City:CORONADO
Mailing Address - State:CA
Mailing Address - Zip Code:92178-1770
Mailing Address - Country:US
Mailing Address - Phone:619-964-9649
Mailing Address - Fax:619-996-2014
Practice Address - Street 1:131 ORANGE AVE STE 101
Practice Address - Street 2:
Practice Address - City:CORONADO
Practice Address - State:CA
Practice Address - Zip Code:92118-1408
Practice Address - Country:US
Practice Address - Phone:619-522-0399
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2018-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207RG0100X
CAA54452207RI0008X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0008XAllopathic & Osteopathic PhysiciansInternal MedicineHepatologyGroup - Multi-Specialty
No207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A544520Medicaid
CA00A544520Medicaid
CAF06609Medicare UPIN