| Organization Name: | CENTINELA VALLEY IPA MEDICAL GROUP |
| NPI Number: | 1164552378 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | ANITHA MITCHELL (PRESIDENT) |
| Mailing Address: | 955 Overland Ct Fl 2 San Dimas |
| State: | CA US |
| Postal Code: | 917731718 |
| Phone Number: | 9099716717 |
| Fax Number: | |
| NPI Enumeration Date: | 03/06/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 171W00000X |
| License Number: | 171W00000X |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Other Service Providers |
| Taxonomy Classification: | Contractor |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A person who contracts to supply certain materials or do certain work for a stipulated sum; esp., one whose business is contracting work in any of the building trades. For purposes of the taxonomy, a person who contracts to complete home repairs or modifications to accommodate a health condition (e.g. wheelchair ramp, kitchen counter lowering). |