# CENTINELA MEDICAL GROUP

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** PARKLANE MEDICAL GROUP INC
- **Other names:** PARKLANE MEDICAL GROUP INC
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1043654676
- **Legal business name:** PARKLANE MEDICAL GROUP INC
- **Authorized official:** DR. GEORGE CHIKE IFEORAH LAC, QME (DIRECTOR)
- **Authorized official phone:** (310) 367-3107

## Contact information

- **Practice address:** 12900 AVALON BLVD, LOS ANGELES, CA 90061-2734
- **Practice address phone:** (310) 538-5222
- **Practice address fax:** (310) 532-7888
- **Mailing address:** 12900 AVALON BLVD, LOS ANGELES, CA 90061-2734
- **Mailing address phone:** (310) 538-5222
- **Mailing address fax:** (310) 532-7888

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | FNP 31076 | CA | Yes |

## Other

- **Enumeration date:** 04/25/2013
- **Last updated:** 04/25/2013