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General NPI Number Information
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NPI Number | 1487656864
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Entity Type | Organization
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Legal Business Name | VALLEY GASTROENTEROLGY CONSULTANTS MEDICAL CENTER, INC.
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Dates
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Enumeration Date | 08/15/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1330 W COVINA BLVD SUITE 203
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City | SAN DIMAS
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State | CA
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Zip | 91773-3200
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Country | US
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Telephone | 909-592-6157
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Fax | 909-592-1544
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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 | 91006-7229
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Country | US
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Telephone | 909-592-6157
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Fax | 909-592-1544
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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 | 909-592-6157
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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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