Centinela Medical Group

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

License

FNP 31076 Issued in CA

Legal business name

CENTINELA MEDICAL GROUP

Practice address

12900 Avalon Blvd
Los Angeles, CA 90061-2734

Phone

(310) 538-5222

Fax

(310) 532-7888

NPI assigned

Apr 25, 2013

Last updated

Apr 25, 2013By the provider in NPPES

Organization subpart

Yes

Parent organization

PARKLANE MEDICAL GROUP INCAs reported in NPPES

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

Authorized official

Name

Dr. George Chike Ifeorah, LAC, QME

Title

Director

Phone

(310) 367-3107

Specialties & licenses 1

Addresses

Other names 1

• PARKLANE MEDICAL GROUP INC Former legal business name

Tax ID family

Centinela Medical Group2 organizations share this tax ID, including this one

Part of

Parklane Medical Group

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Centinela Medical Group

  • General Practice Physician
  • Los Angeles, CA
  • NPI 1902215577
  NPD tax ID

Locations

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

{
    "created_epoch": "1366848000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1366848000000",
    "number": "1043654676",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12900 AVALON BLVD",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900612734",
            "telephone_number": "310-538-5222",
            "fax_number": "310-532-7888"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12900 AVALON BLVD",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900612734",
            "telephone_number": "310-538-5222",
            "fax_number": "310-532-7888"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTINELA MEDICAL GROUP",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PARKLANE MEDICAL GROUP INC",
        "enumeration_date": "2013-04-25",
        "last_updated": "2013-04-25",
        "status": "A",
        "authorized_official_last_name": "IFEORAH",
        "authorized_official_first_name": "GEORGE",
        "authorized_official_middle_name": "CHIKE",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "310-367-3107",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "LAC, QME"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "CA",
            "license": "FNP 31076",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PARKLANE MEDICAL GROUP INC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Centered Individual & Family Counseling Inc
• Centered Self Psychotherapy PC
• Centerimt Los Angeles (CenterIMT Orange County)
• Centinela Hospital Medical Center
• Centinela Joseph Dental Group (EZ Dental and Orthodontics)
• Centinela Medical Group
• Darls Centola, LCSW
• Hugo Centomo, M.D PH.D.
• Central City Community Health Center Inc
• Central City Community Health Center Inc

• General Practice Physician in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• General Practice Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 25, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.