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SOCAL GASTROENTEROLOGY CORP.
NPI 1124770508
Internal Medicine - Gastroenterology in Los Alamitos, CA

Active since January 26, 2022CLIA 05D2268585 · Certificate of Compliance
10931 CHERRY ST STE 300, LOS ALAMITOS, CA 90720(562) 493-1011(562) 594-9226 Get Directions Write a Review

NPPES record last updated: March 11, 2022. Verified against the NPPES registry weekly; last sync: October 18, 2026.

Record update history: Mar 11, 2022, Jan 26, 2022 (2 updates tracked since 2022).

About Socal Gastroenterology Corp. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SOCAL GASTROENTEROLOGY CORP. (NPI 1124770508) is a healthcare organization registered as a gastroenterology in Los Alamitos, California and active in the NPI registry since January 2022. The organization holds a CLIA Certificate of Compliance certificate valid through July 18, 2027 and lists Olivia Jaquez, Manager, as its authorized official.

NPPES Registry Identity

NPI1124770508
Entity TypeOrganization
Primary Taxonomy207RG0100X
Legal Business NameSOCAL GASTROENTEROLOGY CORP.
Location Address10931 CHERRY ST STE 300Los Alamitos, CA 90720-2496
Mailing Address10931 Cherry St Ste 300Los Alamitos, CA 90720-2496 · (562) 493-1011 · Fax (562) 594-9226
Phone(562) 493-1011
Fax(562) 594-9226
Organization SubpartNo
Authorized OfficialOlivia JaquezManager · (562) 493-1011
Enumeration DateJanuary 26, 2022
Last NPPES UpdateMarch 11, 20222 updates tracked since enumeration
NPPES CertifiedMarch 11, 2022
✔ NPI 1124770508 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyInternal Medicine · GastroenterologyAllopathic & Osteopathic Physicians
Taxonomy Code207RG0100X
Definition
An internist who specializes in diagnosis and treatment of diseases of the digestive organs including the stomach, bowels, liver and gallbladder. This specialist treats conditions such as abdominal pain, ulcers, diarrhea, cancer and jaundice and performs complex diagnostic and therapeutic procedures using endoscopes to visualize internal organs.
10931 CHERRY ST STE 300, Los Alamitos, CA 90720
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Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Socal Gastroenterology Corp. is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

4

Medicare enrollment records show 4 clinicians reassign Medicare billing to Socal Gastroenterology Corp., which bills Medicare for the services they deliver. Of these, 2 practice within 10 miles. They are listed nearest first.

Clinicians, nearest first (4)

Joe Chen, M.D.
Gastroenterology
NPI 1700817350
10861 CHERRY STREET SUITE 302
Los Alamitos, CA 90720
(562) 493-1011
✔ PECOS✔ Accepts Medicare0.1 mi
Thai-Van Nguyen, M.D.
Gastroenterology
NPI 1427082890
10861 CHERRY STREET SUITE 302
Los Alamitos, CA 90720
(562) 493-1011
✔ PECOS✔ Accepts Medicare0.1 mi
Rooba Wardeh, M.D
Pathology
NPI 1831388206
101 THE CITY DR S
Orange, CA 92868
(714) 456-6141
✔ PECOS✔ Accepts Medicare10 mi
Timnit Tekeste, M.D.
Gastroenterology
NPI 1689038721
4733 W SUNSET BLVD FL 3
Los Angeles, CA 90027
(206) 226-6668
✔ PECOS✔ Accepts Medicare24 mi

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Compliance 05D2268585

Socal Gastroenterology · Los Alamitos, CA
Active · expires Jul 18, 2027
CLIA Number05D2268585
Laboratory TypePhysician Office
Certificate Effective DateJuly 19, 2025
Certificate Expiration DateJuly 18, 2027
Laboratory DirectorRooba Wardeh
Laboratory Phone(562) 493-1011
Laboratory LocationSocal Gastroenterology10931 Cherry St, Ste 300, Los Alamitos, CA 90720
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Socal Gastroenterology Corp.'s NPI number?

The NPI number for Socal Gastroenterology Corp. is 1124770508. It was assigned to this organization in the NPPES registry on January 26, 2022.

Where is Socal Gastroenterology Corp. located?

Socal Gastroenterology Corp. is located at 10931 Cherry St Ste 300, Los Alamitos, CA 90720. The listed phone number is (562) 493-1011.

What is Socal Gastroenterology Corp.'s specialty?

The primary specialty registered for this NPI is Internal Medicine, specializing in Gastroenterology, with taxonomy code 207RG0100X.

Is Socal Gastroenterology Corp. enrolled in Medicare?

Yes. Socal Gastroenterology Corp. is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Socal Gastroenterology Corp.?

According to the CMS Revalidation Reassignment List (October 2026 release), 4 clinicians in 2 Medicare specialties reassign their Medicare billing to Socal Gastroenterology Corp.. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. The largest specialties are Gastroenterology (3) and Pathology (1). Of these, 2 practice within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Does Socal Gastroenterology Corp. hold a CLIA laboratory certificate?

Yes. A Certificate of Compliance (number 05D2268585) is associated with this NPI, valid through July 18, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Socal Gastroenterology Corp. was last updated on March 11, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.