| Advanced Gastroenterology, Inc. | |
|
2230 Lynn Road Suite 104 Thousand Oaks CA 91360-1959 | |
| (805) 497-0961 | |
| (805) 777-1730 |
| Full Name | Advanced Gastroenterology, Inc. |
|---|---|
| Speciality | Internal Medicine |
| Location | 2230 Lynn Road, Thousand Oaks, California |
| Authorized Official Name and Position | Gilbert Simoni (OWNER) |
| Authorized Official Contact | 8054970961 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Advanced Gastroenterology, Inc. 2230 Lynn Road Suite 104 Thousand Oaks CA 91360-1959 Ph: (805) 497-0961 | Advanced Gastroenterology, Inc. 2230 Lynn Road Suite 104 Thousand Oaks CA 91360-1959 Ph: (805) 497-0961 |
| NPI Number | 1497970875 |
|---|---|
| Provider Enumeration Date | 04/13/2007 |
| Last Update Date | 09/26/2007 |
| Medicare PECOS PAC ID | 2668571688 |
|---|---|
| Medicare Enrollment ID | O20070615000399 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1497970875 | NPI | - | NPPES |
| W20758 | Other | CA | MEDICARE GROUP ID |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RG0100X | Internal Medicine - Gastroenterology | A77140 (California) | Primary |
| Provider Name | Gilbert Simoni |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1316922958 PECOS PAC ID: 7315970787 Enrollment ID: I20061120000297 |
| Provider Name | Fernanda Monteon Ibarra |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1851990550 PECOS PAC ID: 5193112357 Enrollment ID: I20220419000561 |
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