Healthcare Provider Details

I. General information

NPI: 1821090366
Provider Name (Legal Business Name): VALLEY DIGESTIVE HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

488 E SANTA CLARA ST SUITE 102
ARCADIA CA
91006-7229
US

IV. Provider business mailing address

1330 W COVINA BLVD SUITE 203
SAN DIMAS CA
91773-3200
US

V. Phone/Fax

Practice location:
  • Phone: 626-359-9555
  • Fax: 626-359-9556
Mailing address:
  • Phone: 909-592-6157
  • Fax: 909-592-1544

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number StateCA

VIII. Authorized Official

Name: DR. ELIAS ALBERT TARAKJI
Title or Position: PRESIDENT
Credential: M.D.
Phone: 626-359-9555