Organization Name: | CENTINELA MEDICAL GROUP |
NPI Number: | 1043654676 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | GEORGE CHIKE IFEORAH (DIRECTOR) |
Mailing Address: | 12900 Avalon Blvd Los Angeles |
State: | CA US |
Postal Code: | 900612734 |
Phone Number: | 3105385222 |
Fax Number: | 3105327888 |
NPI Enumeration Date: | 04/25/2013 |
NPI Last Update Date: | 04/25/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | FNP 31076 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CA |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |