Provider Demographics
NPI:1487252359
Name:WESTSIDE GASTROENTEROLOGY AND HEPATOLOGY
Entity type:Organization
Organization Name:WESTSIDE GASTROENTEROLOGY AND HEPATOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TOVA
Authorized Official - Middle Name:
Authorized Official - Last Name:SOFER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-986-0555
Mailing Address - Street 1:2080 CENTURY PARK E STE 1200
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90067-2015
Mailing Address - Country:US
Mailing Address - Phone:310-986-0555
Mailing Address - Fax:
Practice Address - Street 1:2080 CENTURY PARK E STE 1200
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90067-2015
Practice Address - Country:US
Practice Address - Phone:310-986-0555
Practice Address - Fax:413-643-6360
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-13
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty