Organization
PACIFIC GASTROENTEROLOGY ENDOSCOPY CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. OM P CHAURASIA MD (PRESIDENT)
(949) 365-8836
Entity
Organization
Contact information
Practice address
26421 CROWN VALLEY PKWY, SUITE 140B, MISSION VIEJO, CA 92691-8564
(949) 365-8836
Mailing address
26421 CROWN VALLEY PKWY, SUITE 140B, MISSION VIEJO, CA 92691-8564
(949) 365-8836
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
060000855
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
060000855
STATE FACILITY LICENSE
CA
01
—
AS1598
BLUE CROSS FACILITY ID
CA
01
—
ZZZH3075Z
BLUE SHIELD FACILITY ID
CA
Enumeration date
02/09/2007
Last updated
06/03/2015
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