SOUTHERN CALIFORNIA LIVER AND GI CENTER NPI 1346790870

Nurse Practitioner (Family) in Pacific Grove, CA

NPI 1346790870 Organization Nurse Practitioner Family CLIA Number 05D1089853 CLIA Certificate of Waiver

About SOUTHERN CALIFORNIA LIVER AND GI CENTER

Southern California Liver And Gi Center is a provider established in Pacific Grove, California specializing in nurse practitioner (family) . The NPI number of Southern California Liver And Gi Center is 1346790870 and was assigned on October 2016. The practitioner's primary taxonomy code is 363LF0000X with license number 11999 (CA). The provider is registered as an organization and their NPI record was last updated 5 years ago. Southern California Liver And Gi Center operates as a single speciality business group with one or more individual providers who practice the same area of specialization. The authorized official of this NPI record is Dr. Tarek Hassanein Md (Medical Director)

A nurse practitioner (NP) like Southern California Liver And Gi Center is an experienced registered nurse with a master’s or doctoral degree and advanced clinical training. Nurse practitioners can work in many different specialties including primary care, pediatrics, cardiology, emergency, women’s health, oncology or geriatrics. Nurse practitioners provide services like physical exams, order laboratory tests, manage diseases, write prescriptions, etc.

The CLIA number of Southern California Liver And Gi Center is 05D1089853 registered as a "physician office" facility with a CLIA Certificate of Waiver. This CLIA certificate is issued to Southern California Liver And Gi Center to perform only waived tests. CLIA defines waived tests as simple tests with a low risk for an incorrect result. Waived tests include certain tests listed in CLIA regulations, tests cleared by the FDA for home use and tests approved by the FDA for waived status and that meet CLIA waiver criteria.

NPI

1346790870

Provider NameSOUTHERN CALIFORNIA LIVER AND GI CENTER
Provider Location Address468 GIBSON AVE PACIFIC GROVE, CA 93950
Provider Mailing Address675 CAMINO DE LOS MARES SAN CLEMENTE, CA 92673
NPI Entity TypeOrganization
Is Sole Proprietor?N/A
Is Organization Subpart?No
Enumeration Date10-07-2016
Last Update Date10-07-2016


Primary Taxonomy

Taxonomy Code363LF0000X
ClassificationNurse Practitioner
TypePhysician Assistants & Advanced Practice Nursing Providers
SpecializationFamily
License No.11999
License StateCA

Business Address

SOUTHERN CALIFORNIA LIVER AND GI CENTER
468 GIBSON AVE
PACIFIC GROVE, CA
ZIP 93950
Phone: (619) 840-2720

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Mailing Address

SOUTHERN CALIFORNIA LIVER AND GI CENTER
675 CAMINO DE LOS MARES
SAN CLEMENTE, CA
ZIP 92673
Phone: (619) 522-0399



Authorized Official

Authorized Official NameDR. TAREK HASSANEIN MD
Authorized Official TitleMEDICAL DIRECTOR
Authorized Official Phone(619) 522-0399

CLIA Information

The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for the NPI number 1346790870 is:

CLIA Number05D1089853
Facility TypePHYSICIAN OFFICE
Certificate TypeCertificate of Waiver

Group Taxonomy


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

NPI Footnotes

What is the National Provider Indentifier (NPI)?
The NPI is 10-position all-numeric identification number assigned by the NPPES to uniquely identify a health care provider.

Provider Location Address
The location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.

Provider Mailing Address
The mailing address of the provider being identified. This address may contain the same information as the provider location address.

Entity Type Code
The code describing the type of health care provider that is being assigned an NPI.
The entity type codes are:
1 = Person: individual human being who furnishes health care;
2 = Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)

What is a Subpart?
Subparts are the components and separate physical locations of organization health care providers. Subpart examples include:
Hospital components include outpatient departments, surgical centers, psychiatric units, and laboratories. These components are often separately licensed or certified by States and may exist at physical locations other than that of the hospital of which they are a component.

Provider Other Organization Name
The other organization name is the alternative last name by which the provider is or has been known (if an individual) or other name by which the organization provider is or has been known. The code identifying the type of other name. The provider other organization name codes are:
1 = former name;
2 = professional name;
3 = doing business as (d/b/ a) name;
4 = former legal business name; :
5 = other.

Provider Enumeration Date
The date the provider was assigned a unique identifier (assigned an NPI).

Last Update Date
The date that a NPI record was last updated or changed.

Primary Taxonomy Code
The primary taxonomy code defines the provider type, classification, and specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.

Authorized Official Name
The name of the person authorized to submit the NPI application or to officially change data for a health care provider.