Provider Demographics
NPI:1912065665
Name:WEST VALLEY PEDIATRIC GASTROENTEROLOGY AND NUTRITION, INC.
Entity Type:Organization
Organization Name:WEST VALLEY PEDIATRIC GASTROENTEROLOGY AND NUTRITION, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:C
Authorized Official - Last Name:SEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-715-7147
Mailing Address - Street 1:23101 SHERMAN PL
Mailing Address - Street 2:SUITE 311
Mailing Address - City:WEST HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91307-2003
Mailing Address - Country:US
Mailing Address - Phone:805-584-9476
Mailing Address - Fax:805-583-1729
Practice Address - Street 1:23101 SHERMAN PL
Practice Address - Street 2:SUITE 311
Practice Address - City:WEST HILLS
Practice Address - State:CA
Practice Address - Zip Code:91307-2003
Practice Address - Country:US
Practice Address - Phone:805-584-9476
Practice Address - Fax:805-583-1729
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA44890133N00000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Single Specialty
Not Answered174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A448901Medicaid
CA00A448901Medicaid
CAA44890Medicare UPIN