# CENTINELA MEDICAL GROUP

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

## Provider details

- **NPI number:** 1902215577
- **Legal business name:** PARKLANE MEDICAL GROUP
- **Authorized official:** DR. GEORGE CHIKE IFEORAH LAC,QME (DIRECTOR)
- **Authorized official phone:** (310) 367-3107

## Contact information

- **Practice address:** 4405 S MAIN ST, LOS ANGELES, CA 90037-2731
- **Practice address phone:** (323) 231-0965
- **Practice address fax:** (323) 231-6512
- **Mailing address:** 4405 S MAIN ST, LOS ANGELES, CA 90037-2731
- **Mailing address phone:** (323) 231-0965
- **Mailing address fax:** (323) 231-6512

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | FNP31076 | CA | Yes |

## Other

- **Enumeration date:** 08/08/2014
- **Last updated:** 08/08/2014