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General NPI Number Information
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NPI Number | 1285780692
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Entity Type | Organization
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Legal Business Name | ADVANCED GASTROENTEROLOGY OF MONTEREY COUNTY MEDICAL CORP
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Dates
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Enumeration Date | 01/26/2007
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Last Update Date | 02/14/2018
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Provider Practice Location Address
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Address Line | 1441 CONSTITUTION BLVD
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City | SALINAS
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State | CA
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Zip | 93906-3100
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Country | US
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Telephone | 831-755-6352
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Fax | 831-755-6297
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Provider Business Mailing Address
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Address Line | 395 DEL MONTE CENTER STE 173
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City | MONTEREY
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State | CA
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Zip | 93940-6156
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Country | US
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Telephone | 831-755-6352
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Fax | 831-372-1666
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Authorized Official
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Title or Position | OWNER
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Name | DR. MUMTAZ TABBAA
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Credential | M.D.
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Telephone | 831-755-6352
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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 | A54688
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License Number State | CA
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