Healthcare Provider Details

I. General information

NPI: 1417008707
Provider Name (Legal Business Name): OCIGE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2007
Last Update Date: 06/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26732 CROWN VALLEY PKWY SUITE 241
MISSION VIEJO CA
92691-6306
US

IV. Provider business mailing address

26732 CROWN VALLEY PKWY SUITE 241
MISSION VIEJO CA
92691-6306
US

V. Phone/Fax

Practice location:
  • Phone: 949-364-2611
  • Fax: 949-364-0226
Mailing address:
  • Phone: 949-364-2611
  • Fax: 949-364-0226

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0800X
TaxonomyEndoscopy Clinic/Center
License Number060000405
License Number StateCA

VIII. Authorized Official

Name: AHMAD M SHABAN
Title or Position: MEDICAL DIRECTOR - OWNER
Credential: M.D.
Phone: 949-364-2611