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General NPI Number Information
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NPI Number | 1497807184
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Entity Type | Organization
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Legal Business Name | PEDIATRIC GASTROENTEROLOGY MEDICAL CENTER, INC.
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Dates
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Enumeration Date | 01/16/2007
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Last Update Date | 10/22/2025
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Provider Practice Location Address
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Address Line | 16661 VENTURA BLVD STE 718
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City | ENCINO
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State | CA
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Zip | 91436-1995
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Country | US
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Telephone | 818-986-0006
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Fax | 818-986-2333
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Provider Business Mailing Address
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Address Line | 16661 VENTURA BLVD STE 718 SUITE 718
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City | ENCINO
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State | CA
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Zip | 91436-1995
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Country | US
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Telephone | 818-986-0006
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Fax | 818-986-2333
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SAIED DALLALZADEH
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Credential | M.D.
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Telephone | 818-986-0006
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080P0206X
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Taxonomy Name | Pediatric Gastroenterology Physician
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License Number | 00300204
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License Number State | CA
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