Provider Demographics
NPI:1942328273
Name:CITRUS VALLEY GASTROENTEROLOGY A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:CITRUS VALLEY GASTROENTEROLOGY A MEDICAL CORPORATION
Other - Org Name:CITRUS VALLEY GASTROENTEROLOGY A CALIFORNIA MEDICAL CORPORATION
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:SARTAJ
Authorized Official - Middle Name:M
Authorized Official - Last Name:ARORA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-737-1066
Mailing Address - Street 1:415 W ROUTE 66
Mailing Address - Street 2:# 102
Mailing Address - City:GLENDORA
Mailing Address - State:CA
Mailing Address - Zip Code:91740-4335
Mailing Address - Country:US
Mailing Address - Phone:626-610-2112
Mailing Address - Fax:626-610-2119
Practice Address - Street 1:415 W ROUTE 66
Practice Address - Street 2:# 102
Practice Address - City:GLENDORA
Practice Address - State:CA
Practice Address - Zip Code:91740-4335
Practice Address - Country:US
Practice Address - Phone:626-610-2112
Practice Address - Fax:626-610-2119
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1942328273OtherNPI