# GASTROENTEROLOGY DIAGNOSTIC CENTER MEDICAL GROUP, A PROFESSIONAL

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Gastroenterology Diagnostic Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1013048461
- **Authorized official:** FERNANDO IBARRA MD (AUTHORIZED OFFICIAL)
- **Authorized official phone:** (626) 872-6261

## Contact information

- **Practice address:** 880 S ATLANTIC BLVD, SUITE G 10, MONTEREY PARK, CA 91754-4700
- **Practice address phone:** (626) 872-6261
- **Practice address fax:** (626) 872-1948
- **Mailing address:** 880 S ATLANTIC BLVD, \#G 10, MONTEREY PARK, CA 91754-4700
- **Mailing address phone:** (626) 872-6261
- **Mailing address fax:** (626) 872-1948

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QA1903X | Ambulatory Surgical Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 03/08/2007
- **Last updated:** 01/15/2020