Provider Demographics
NPI:1982181939
Name:CAL MED ENDOSCOPY CENTER LLC
Entity Type:Organization
Organization Name:CAL MED ENDOSCOPY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEV
Authorized Official - Middle Name:
Authorized Official - Last Name:GNANADEV
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-580-3353
Mailing Address - Street 1:1281 W C ST
Mailing Address - Street 2:
Mailing Address - City:COLTON
Mailing Address - State:CA
Mailing Address - Zip Code:92324-1916
Mailing Address - Country:US
Mailing Address - Phone:909-679-2754
Mailing Address - Fax:909-423-0138
Practice Address - Street 1:1281 W C ST
Practice Address - Street 2:
Practice Address - City:COLTON
Practice Address - State:CA
Practice Address - Zip Code:92324-1916
Practice Address - Country:US
Practice Address - Phone:909-580-3353
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-23
Last Update Date:2022-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0800XAmbulatory Health Care FacilitiesClinic/CenterEndoscopy