Healthcare Provider Details

I. General information

NPI: 1548845167
Provider Name (Legal Business Name): GASTROINTESTINAL & NON-SURGICAL WEIGHT LOSS SOLUTIONS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2021
Last Update Date: 01/26/2026
Certification Date: 01/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

623 W DUARTE RD STE 8
ARCADIA CA
91007-7349
US

IV. Provider business mailing address

122A E FOOTHILL BLVD UNIT 304
ARCADIA CA
91006-2505
US

V. Phone/Fax

Practice location:
  • Phone: 626-461-5408
  • Fax: 626-461-5436
Mailing address:
  • Phone: 626-461-5408
  • Fax: 626-461-5436

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State

VIII. Authorized Official

Name: DONALD J PORTOCARRERO
Title or Position: AUTHORIZED OFFICIAL
Credential: DO
Phone: 626-461-5406