MEDICARE: DIGESTIVE DISEASE CENTER, LP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QA1903X	Ambulatory Surgical Clinic/Center

General Provider Information

NPI Number	:	1417935206
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIGESTIVE DISEASE CENTER, LP

Provider Business Mailing Address
First Line	:	24411 HEALTH CENTER DR
Second Line	:	SUITE 450
City	:	LAGUNA HILLS
State	:	CA
Zip	:	92653-3633
Country	:	US
Telephone Number	:	949-586-9386
Fax Number	:	949-586-0864

Provider Business Practice Location Address
First Line	:	24411 HEALTH CENTER DR
Second Line	:	SUITE 450
City	:	LAGUNA HILLS
State	:	CA
Zip	:	92653-3633
Country	:	US
Telephone Number	:	949-586-9386
Fax Number	:	949-586-0864

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	CAROLYN KNUTZEN
Credential	:
Telephone Number	:	949-586-9386

Provider Enumeration Date	:	01/03/2006
Last Update Date	:	08/03/2017

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