Organization
CENTRELAKE MEDICAL GROUP INC
Active
Other names
Centrelake Imaging & Oncology
Organization subpart
No
Provider details
NPI number
Authorized official
TANIA CEJA (SITE MANAGER)
(909) 242-7300
Entity
Organization
Contact information
Practice address
1900 E LA PALMA AVE STE D, ANAHEIM, CA 92805-1647
(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
261QR0200X
Radiology Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0103950
—
CA
Enumeration date
05/24/2021
Last updated
05/24/2021
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