CENTRELAKE MEDICAL GROUP INC NPI 1760721112

NPI Information

NPI: 1760721112
Provider Name: CENTRELAKE MEDICAL GROUP INC

Doing Business As: CENTRELAKE IMAGING & ONCOLOGY

Classification: Clinic/Center - 261QR0200X
Entity Type: Organization

Specialization: Radiology

CLIA Number: 05D2071493

Address:
1700 W WEST COVINA PKWY
WEST COVINA, CA
ZIP 91790
Phone: (909) 242-7300
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CENTRELAKE MEDICAL GROUP INC is a radiology clinic center in West Covina, CA. CENTRELAKE MEDICAL GROUP INC NPI is 1760721112. The provider is registered as an organization entity type.
The provider Is Doing Business As Centrelake Imaging & Oncology.

The provider's business location address is:

1700 W WEST COVINA PKWY
WEST COVINA, CA
ZIP 91790-706
Phone: (909) 242-7300
Fax: (909) 784-3760

The provider's authorized official is Amar A Lapsi .
The authorized official title is Chief Operating Officer and has the following contact phone number (626) 331-6866.

The CLIA number assigned to this NPI record is 05D2071493 - ambulatory surgery center with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 2/5/2013 and was last updated on 5/24/2021.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QR0200X	Clinic/Center	Radiology	FNP34299	CALIFORNIA	Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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