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Organization
PARKLANE MEDICAL GROUP
Active
Organization
PARKLANE MEDICAL GROUP
Active
Other names
CENTINELA MEDICAL GROUP
Organization subpart
No
Provider details
NPI number
Authorized official
GEORGE C IFEORAH LAC (DIRECTOR)
(310) 538-5222
Entity
Organization
Contact information
Practice address
12900 SOUTH AVALON BL., LOS ANGELES, CA 90061
(310) 538-5222
(310) 532-7888
Mailing address
12900 SOUTH AVALON BL., LOS ANGELES, CA 90061
(310) 538-5222
(310) 532-7888
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0102062
—
CA
Enumeration date
05/15/2007
Last updated
08/22/2020
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