MEDICARE: SOUTHERN CALIFORNIA HOSPITALIST GROUP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	282N00000X	General Acute Care Hospital	20A10575	CA

General Provider Information

NPI Number	:	1053683953
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHERN CALIFORNIA HOSPITALIST GROUP

Provider Business Mailing Address
First Line	:	5457 TURQUOISE AVE
Second Line	:
City	:	RANCHO CUCAMONGA
State	:	CA
Zip	:	91701-1227
Country	:	US
Telephone Number	:	909-527-3651
Fax Number	:

Provider Business Practice Location Address
First Line	:	5457 TURQUOISE AVE
Second Line	:
City	:	RANCHO CUCAMONGA
State	:	CA
Zip	:	91701-1227
Country	:	US
Telephone Number	:	909-527-3651
Fax Number	:

Authorized Official
Title or Position	:	MEDICAL DIRECTOR/CEO/PRESIDENT
Name	:	DR. ALIDAD M ZADEH
Credential	:	D.O.
Telephone Number	:	909-527-3651

Provider Enumeration Date	:	02/08/2012
Last Update Date	:	02/08/2012

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