Healthcare Provider Details

I. General information

NPI: 1124207717
Provider Name (Legal Business Name): BARRY A. MORGUELAN INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2007
Last Update Date: 07/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 S ALVARADO ST #602
LOS ANGELES CA
90057-2355
US

IV. Provider business mailing address

201 S ALVARADO ST #602
LOS ANGELES CA
90057-2355
US

V. Phone/Fax

Practice location:
  • Phone: 213-413-5010
  • Fax: 213-413-7734
Mailing address:
  • Phone: 213-413-5010
  • Fax: 213-413-7734

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberG27009
License Number StateCA

VIII. Authorized Official

Name: BARRY A MORGUELAN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 213-413-5010