Healthcare Provider Details

I. General information

NPI: 1457625931
Provider Name (Legal Business Name): GASTROENTEROLOGY & HEPATOLOGY SPECIALISTS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2012
Last Update Date: 04/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1687 ERRINGER RD SUITE 103
SIMI VALLEY CA
93065-6508
US

IV. Provider business mailing address

3288 CASINO DR
THOUSAND OAKS CA
91362-4802
US

V. Phone/Fax

Practice location:
  • Phone: 805-462-4463
  • Fax: 866-496-4990
Mailing address:
  • Phone: 805-492-4463
  • Fax: 866-496-4990

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberA91177
License Number StateCA

VIII. Authorized Official

Name: MAYUR TRIVEDI
Title or Position: PRESIDENT
Credential: MD
Phone: 805-492-4463