=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225793235
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SOUTHERN CALIFORNIA CENTER FOR ADVANCED GYNECOLOGY A MEDICAL CORP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/04/2021
-----------------------------------------------------
Last Update Date | 11/22/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11100 WARNER AVE STE 116
-----------------------------------------------------
City | FOUNTAIN VALLEY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92708-7500
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 657-356-1281
-----------------------------------------------------
Fax | 310-602-6190
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3010 BEARD RD
-----------------------------------------------------
City | NAPA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94558-3442
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 707-255-8825
-----------------------------------------------------
Fax | 707-252-9325
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. SALMAN N. M. OKOUR
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 310-367-3648
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207V00000X
-----------------------------------------------------
Taxonomy Name | Obstetrics & Gynecology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------