Organization
CHILDRENS GASTROENTEROLOGY MCSG
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RICHARD K MATHIS M.D. (MEDICAL DIRECTOR)
(562) 933-6900
Entity
Organization
Contact information
Practice address
1760 TERMINO AVE, SUITE 300, LONG BEACH, CA 90804-2105
(562) 933-6900
(562) 933-8557
Mailing address
PO BOX 20360, LONG BEACH, CA 90801-3360
(562) 933-6900
(562) 933-8557
Taxonomy
Speciality
Code
Description
License number
State
2080P0206X
Pediatric Gastroenterology Physician
Primary
A24038
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00A240380
DR. MATHIS IND MEDI-CAL NUMBER
CA
01
—
00A549840
DR. SELA-HERMAN IND MEDICAL NUMBER
CA
Enumeration date
04/06/2009
Last updated
04/06/2009
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