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Organization
CENTINELA VALLEY IPA MEDICAL GROUP
Active
Organization
CENTINELA VALLEY IPA MEDICAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ANITHA MITCHELL (PRESIDENT)
(310) 673-9499
Entity
Organization
Contact information
Practice address
955 OVERLAND CT FL 2, SAN DIMAS, CA 91773-1718
(909) 971-6717
Mailing address
PO BOX 4069, COVINA, CA 91723-0469
(909) 971-6717
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
171W00000X
CA
Other
Enumeration date
03/06/2007
Last updated
08/22/2020
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