Socal Gastroenterology Corp.

Primary specialty

Gastroenterology PhysicianTaxonomy code 207RG0100X

Legal business name

SOCAL GASTROENTEROLOGY CORP.

Practice address

10931 Cherry St Ste 300
Los Alamitos, CA 90720-2496

Phone

(562) 493-1011

Fax

(562) 594-9226

NPI assigned

Jan 26, 2022

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Olivia Jaquez

Title

Manager

Phone

(562) 493-1011

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Interoperability endpoints

• FHIR API: https://fhir-api.fhirprod.aws.greenwayhealth.com/fhir/R4/2.16.840.1.113883.3.140.73769

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Joe Meannan Chen, M.D.

  • Gastroenterology Physician
  • Los Alamitos, CA
  • NPI 1700817350
  Medicare reassignment Care Compare group NPD
• Thai-Van Xuan Nguyen, M.D.

  • Gastroenterology Physician
  • Los Alamitos, CA
  • NPI 1427082890
  Medicare reassignment Care Compare group NPD
• Timnit Fesehaye Tekeste, M.D.

  • Gastroenterology Physician
  • Los Angeles, CA
  • NPI 1689038721
  Medicare reassignment Care Compare group NPD
• Rooba Wardeh, M.D

  • Anatomic Pathology & Clinical Pathology Physician
  • Orange, CA
  • NPI 1831388206
  Medicare reassignment Care Compare group NPD
• Alfred T Reyno, PA-C

  • Physician Assistant
  • Los Alamitos, CA
  • NPI 1093832578
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1643155200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1646956800000",
    "number": "1124770508",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10931 CHERRY ST STE 300",
            "city": "LOS ALAMITOS",
            "state": "CA",
            "postal_code": "907202496",
            "telephone_number": "562-493-1011",
            "fax_number": "562-594-9226"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10931 CHERRY ST STE 300",
            "city": "LOS ALAMITOS",
            "state": "CA",
            "postal_code": "907202496",
            "telephone_number": "562-493-1011",
            "fax_number": "562-594-9226"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOCAL GASTROENTEROLOGY CORP.",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-01-26",
        "last_updated": "2022-03-11",
        "certification_date": "2022-03-11",
        "status": "A",
        "authorized_official_last_name": "JAQUEZ",
        "authorized_official_first_name": "OLIVIA",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "562-493-1011"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Gastroenterology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alexander Smith
• Robert S Smith, PH.D.
• Roberta Marie Smith, PA
• Wesley Eugene Smith
• Crystal Sobrian, REGISTERED NURSE
• Socal Medical Specialist Medical Corporation
• Dana Son
• Brooklyn Nyela Sosa
• Southern California Neurodiagnostic Center, Inc
• Southern California Urology, Inc.

• Gastroenterology Physician in Los Alamitos, CA
• Providers in Los Alamitos, CA by specialty
• Gastroenterology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.