Organization
CENTRELAKE MEDICAL GROUP INC
Active
Parent organization
CENTRELAKE MEDICAL GROUP INC
Other names
Centrelake Imaging & Oncology
Organization subpart
Yes
Provider details
NPI number
Legal business name
CENTRELAKE MEDICAL GROUP INC
Authorized official
TANIA CEJA (LEAD SITE MANAGER)
(909) 242-7300
Entity
Organization
Contact information
Practice address
430 W STETSON AVE, HEMET, CA 92543-7328
(909) 242-7300
(909) 784-3760
Mailing address
3115 E GUASTI RD, ONTARIO, CA 91761-7853
(909) 242-7300
(909) 784-3760
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
NA
RADIOLOGY
—
05
—
XXX
—
CA
Enumeration date
10/19/2020
Last updated
10/19/2020
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