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General NPI Number Information
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NPI Number | 1013061167
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Entity Type | Organization
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Legal Business Name | VALLEY GASTOENTEROLOGY CONSULTANTS
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Dates
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Enumeration Date | 01/23/2007
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Last Update Date | 04/25/2011
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Provider Practice Location Address
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Address Line | 415 W CARROLL AVE SUITE 201
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City | GLENDORA
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State | CA
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Zip | 91741-4208
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Country | US
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Telephone | 626-963-2490
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Fax | 626-963-2495
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Provider Business Mailing Address
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Address Line | 488 E SANTA CLARA ST SUITE 103
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City | ARCADIA
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State | CA
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Zip | 91006-7231
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Country | US
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Telephone | 626-359-3330
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Fax | 626-359-3339
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SAMUEL MOURANI
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Credential | M.D.
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Telephone | 626-359-3330
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number |
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License Number State |
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