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General NPI Number Information
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NPI Number | 1306482237
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Entity Type | Organization
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Legal Business Name | B & G MEDICAL AND SURGICAL PROVIDERS A PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 11/26/2019
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Last Update Date | 11/26/2019
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Provider Practice Location Address
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Address Line | 10660 WILSHIRE BLVD APT 1108
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City | LOS ANGELES
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State | CA
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Zip | 90024-4526
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Country | US
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Telephone | 310-490-8181
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Fax |
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Provider Business Mailing Address
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Address Line | 10660 WILSHIRE BLVD APT 1108
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City | LOS ANGELES
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State | CA
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Zip | 90024-4526
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Country | US
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Telephone | 310-490-8181
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Fax |
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Authorized Official
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Title or Position | DOCTOR
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Name | ELHAM GADISHAH
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Credential | M.D.
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Telephone | 310-490-8181
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State |
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