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General NPI Number Information
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NPI Number | 1528136009
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Entity Type | Organization
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Legal Business Name | FOOTHILLS GASTROENTEROLOGY MEDICAL ASSOCIATES INC
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Dates
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Enumeration Date | 12/01/2006
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Last Update Date | 01/20/2010
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Provider Practice Location Address
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Address Line | 210 S GRAND AVE SUITE 415
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City | GLENDORA
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State | CA
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Zip | 91741-4292
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Country | US
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Telephone | 626-914-1182
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Fax | 626-914-1182
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Provider Business Mailing Address
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Address Line | 210 S GRAND AVE SUITE 415
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City | GLENDORA
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State | CA
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Zip | 91741-4292
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Country | US
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Telephone | 626-914-1182
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Fax | 626-914-9713
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Authorized Official
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Title or Position | PRESIDENT
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Name | GEORGE FERENCZI
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Credential | MD
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Telephone | 626-914-1182
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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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