Organization
CENTINELA RADIOLOGY MEDICAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CRAIG J GOMBERG MD (PARTNER)
(562) 761-7479
Entity
Organization
Contact information
Practice address
555 E HARDY ST, CENTINELA HOSPITAL MEDICAL CENTER, INGLEWOOD, CA 90301-4011
(310) 673-4660
Mailing address
PO BOX 516068, LOS ANGELES, CA 90051-1930
(310) 419-0597
(714) 919-8836
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CR0166
RAILROAD MEDICARE
—
05
—
GR0010880
—
CA
01
—
GR0010881
CALOPTIMA
—
05
—
GR0010881
—
CA
01
—
GR0010882
CALOPTIMA
—
05
—
GR0010882
—
CA
01
—
GR0010883
CALOPTIMA
—
05
—
GR0010883
—
CA
01
—
ZZZ64951Z
BLUE SHIELD
—
01
—
ZZZ64952Z
BLUE SHIELD
—
01
—
ZZZ65765Z
BLUE SHIELD
—
01
—
ZZZ94679Z
BLUE SHIELD
—
Enumeration date
11/29/2005
Last updated
06/09/2026
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