Healthcare Provider Details

I. General information

NPI: 1871633099
Provider Name (Legal Business Name): SOUTHERN CALIFORNIA LIVER CENTERS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 10/14/2025
Certification Date: 10/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131 ORANGE AVE STE 101
CORONADO CA
92118-1408
US

IV. Provider business mailing address

PO BOX 181770
CORONADO CA
92178-1770
US

V. Phone/Fax

Practice location:
  • Phone: 619-522-0399
  • Fax:
Mailing address:
  • Phone: 619-964-9649
  • Fax: 619-996-2014

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RI0008X
TaxonomyHepatology Physician
License NumberA54452
License Number StateCA

VIII. Authorized Official

Name: DR. TAREK I. HASSANEIN
Title or Position: OWNER/PRESIDENT
Credential:
Phone: 619-990-1698