Healthcare Provider Details

I. General information

NPI: 1720078892
Provider Name (Legal Business Name): DIGESTIVE CARE CONSULTANTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2005
Last Update Date: 11/18/2024
Certification Date: 11/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23451 MADISON ST STE 290
TORRANCE CA
90505-4737
US

IV. Provider business mailing address

23451 MADISON ST STE 290
TORRANCE CA
90505-4737
US

V. Phone/Fax

Practice location:
  • Phone: 310-375-1246
  • Fax: 310-375-0590
Mailing address:
  • Phone: 310-375-1246
  • Fax: 310-375-0590

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WG0100X
TaxonomyGastroenterology Registered Nurse
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State

VIII. Authorized Official

Name: STEPHANIE GARCIA
Title or Position: HR
Credential:
Phone: 310-375-1246