Provider Demographics
NPI:1952564965
Name:COMPREHENSIVE GI CARE, A PROFESSIONAL MEDICAL GROUP, INC.
Entity Type:Organization
Organization Name:COMPREHENSIVE GI CARE, A PROFESSIONAL MEDICAL GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:HERTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-596-5552
Mailing Address - Street 1:4772 KATELLA AVE
Mailing Address - Street 2:#200
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720-2683
Mailing Address - Country:US
Mailing Address - Phone:562-596-5552
Mailing Address - Fax:562-596-5340
Practice Address - Street 1:4772 KATELLA AVE
Practice Address - Street 2:#200
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-2683
Practice Address - Country:US
Practice Address - Phone:562-596-5552
Practice Address - Fax:562-596-5340
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-09
Last Update Date:2017-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
E02878Medicare UPIN
W18703Medicare PIN