Centinela Medical Group

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

License

FNP31076 Issued in CA

Legal business name

CENTINELA MEDICAL GROUP

Practice address

4405 S Main St
Los Angeles, CA 90037-2731

Phone

(323) 231-0965

Fax

(323) 231-6512

NPI assigned

Aug 8, 2014

Organization subpart

Yes

Parent organization

PARKLANE MEDICAL GROUPAs 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

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

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 1043654676
  NPD tax ID

Locations

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

{
    "created_epoch": "1407456000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1407456000000",
    "number": "1902215577",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4405 S MAIN ST",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900372731",
            "telephone_number": "323-231-0965",
            "fax_number": "323-231-6512"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4405 S MAIN ST",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900372731",
            "telephone_number": "323-231-0965",
            "fax_number": "323-231-6512"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTINELA MEDICAL GROUP",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PARKLANE MEDICAL GROUP",
        "enumeration_date": "2014-08-08",
        "last_updated": "2014-08-08",
        "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": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": "CA",
            "license": "FNP31076",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PARKLANE MEDICAL GROUP INC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Centered Self Psychotherapy PC
• Centerimt Los Angeles
• Centinela Hospital Medical Center
• Centinela Joseph Dental Group
• Centinela Medical Group
• Darls Centola, LCSW
• Hugo Centomo, M.D PH.D.
• Central City Community Health Center Inc
• 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 Aug 8, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.