Healthcare Provider Details

I. General information

NPI: 1558729459
Provider Name (Legal Business Name): GASTROENTEROLOGY INSTITUTE OF SOUTHERN CALIFORNIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2016
Last Update Date: 02/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 N ROBERTSON BLVD SUITE 204
BEVERLY HILLS CA
90211-2142
US

IV. Provider business mailing address

PO BOX 67672
LOS ANGELES CA
90067-0672
US

V. Phone/Fax

Practice location:
  • Phone: 310-271-1122
  • Fax: 310-271-1126
Mailing address:
  • Phone: 310-273-7365
  • Fax: 310-273-7366

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: PEYTON BEROOKIM
Title or Position: OWNER
Credential: MD
Phone: 310-271-1122