Healthcare Provider Details

I. General information

NPI: 1972654762
Provider Name (Legal Business Name): COVINA ENDOSCOPY CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1794 S BARRANCA AVE
GLENDORA CA
91740-5421
US

IV. Provider business mailing address

1794 S BARRANCA AVE
GLENDORA CA
91740-5421
US

V. Phone/Fax

Practice location:
  • Phone: 626-858-4600
  • Fax: 626-858-4601
Mailing address:
  • Phone: 626-858-4600
  • Fax: 626-858-4601

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: MR. ALI H SAHEBEKHTIARI
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 626-858-4600