Unknown Individual – Gastroenterology Physician, NPI 1790760973

Unknown Individual is a healthcare provider. based in Northridge, California. specializing in Gastroenterology Physician. They hold a License No. 159174 (MA). The NPI Number for Unknown Individual is 1790760973

Main info

Organization
Inactive
33 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1790760973
Phone
(800) 856-1305
Address
18350 ROSCOE BLVD
Deactivation Date
18 February 2022

Doctor Profile

Medical School Name
OTHER
Secondary Phone
8188856261
Graduation Year
1993 (33 years ago)
PAC ID
7315930070
Professional Enrollment ID
I20060804000155
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience14
Completeness75
Years active:0State licenses:1Digital endpointsOther names

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Provider Addresses for Unknown Individual

  • Northridge Hospital Medical Center, 18300, Roscoe Boulevard, Reseda, Los Angeles, Los Angeles County, California, 91328, United States

    SUITE 303

    NORTHRIDGE, CA 913254109

    Phone: (800) 856-1305

    Fax: (818) 476-5614

    Mailing address matches the actual address.

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

No Medicare enrollment or revalidation data available for this provider in our database.

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 91325)

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Reviews

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Frequently asked questions

What NPI should I save for Unknown Individual?
Save NPI 1790760973 if you need a stable reference for Unknown Individual.
How do I interpret inactive records for Unknown Individual?
Treat inactive as a signal to verify Unknown Individual through official channels.
What does Unknown Individual treat or focus on?
Patients typically see Unknown Individual under the specialty Gastroenterology Physician. Clinical services aligned with this taxonomy classification.
Where does public data place Unknown Individual?
The snapshot lists Northridge, California for Unknown Individual; download NPPES for the complete set.
Is this NPI for an individual or an organization?
This listing corresponds to an Individual Provider.

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