Provider Demographics
NPI:1912198276
Name:TERMINO OFFICE - GASTROENTEROLOGY
Entity Type:Organization
Organization Name:TERMINO OFFICE - GASTROENTEROLOGY
Other - Org Name:PEDIATRIC SUBSPECIALTY FACULTY, INC
Other - Org Type:Other Name
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:M
Authorized Official - Last Name:FARACE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-516-4295
Mailing Address - Street 1:455 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-3835
Mailing Address - Country:US
Mailing Address - Phone:714-516-4295
Mailing Address - Fax:
Practice Address - Street 1:1760 TERMINO AVE STE 300
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90804-2157
Practice Address - Country:US
Practice Address - Phone:714-516-4295
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PEDIATRIC SUBSPECIALTY FACULTY, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-08-01
Last Update Date:2008-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2080P0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0206XAllopathic & Osteopathic PhysiciansPediatricsPediatric GastroenterologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0090404Medicaid
CAGR0090396Medicaid
CAGR0090407Medicaid
CAGR0090409Medicaid
CAGR0090405Medicaid
CAGR0090406Medicaid
CAGR009040AMedicaid