Healthcare Provider Details

I. General information

NPI: 1104058932
Provider Name (Legal Business Name): LOS ANGELES INTEGRATIVE GASTROENTEROLOGY & NUTRITION, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2009
Last Update Date: 02/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2080 CENTURY PARK E SUITE 1804
LOS ANGELES CA
90067-2001
US

IV. Provider business mailing address

2080 CENTURY PARK E SUITE 1804
LOS ANGELES CA
90067-2001
US

V. Phone/Fax

Practice location:
  • Phone: 310-289-8000
  • Fax: 310-553-5590
Mailing address:
  • Phone: 310-289-8000
  • Fax: 310-553-5590

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberA 38265
License Number StateCA

VIII. Authorized Official

Name: DR. FARSHID SAM RAHBAR
Title or Position: PRESIDENT
Credential: MD, FACP
Phone: 310-289-8000