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General NPI Number Information
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NPI Number | 1528953882
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Entity Type | Organization
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Legal Business Name | SOUTHERN CALIFORNIA FATTY LIVER CENTER INC
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Dates
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Enumeration Date | 06/09/2025
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Last Update Date | 10/16/2025
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Provider Practice Location Address
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Address Line | 2436 FENTON ST # 100
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City | CHULA VISTA
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State | CA
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Zip | 91914-3516
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Country | US
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Telephone | 619-377-8391
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Fax |
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Provider Business Mailing Address
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Address Line | 131 ORANGE AVE STE 100
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City | CORONADO
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State | CA
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Zip | 92118-1408
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Country | US
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Telephone | 619-377-8391
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Fax |
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Authorized Official
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Title or Position | OPERATIONS
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Name | MR. TAREK HASSANEIN
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Credential |
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Telephone | 619-990-1698
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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