CENTRELAKE MEDICAL GROUP INC (NPI# 1760721112) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1760721112 |
| Entity Type | Organization |
| Organization Name | CENTRELAKE MEDICAL GROUP INC |
| Other Organization Name | CENTRELAKE IMAGING & ONCOLOGY |
| Practice Address |
1700 W West Covina Pkwy West Covina CA 91790-2706 |
| Mailing Address |
3115 E Guasti Rd Ontario CA 91761-7853 |
| Practice Telephone | 9092427300 |
| Practice Fax Number | 9097843760 |
| Mailing Telephone | 9092427300 |
| Mailing Fax Number | 9097843760 |
| Enumeration Date | 2013-02-05 |
| Last Update Date | 2013-02-05 |
| Authorized Official Name | MR. AMAR A LAPSI (CHIEF OPERATING OFFICER) |
| Authorized Official Telephone | 6263316866 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QR0200X |
Clinic/Center Specialization: Radiology |
FNP34299 | CA | Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| Centrelake Imaging & Oncology | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750980967 | Centrelake Medical Group Inc | Radiology | 430 W Stetson Ave, Hemet, CA 92543-7328 | 2020-10-19 |
| 1972070514 | Centrelake Medical Group Inc | Radiology | 11436 Garvey Ave Ste D, El Monte, CA 91732-3304 | 2018-11-01 |
| 1295051365 | Centrelake Medical Group Inc | Radiology | 1433 N Hollenbeck Ave, Suite 105, Covina, CA 91722-1558 | 2010-04-14 |
| Street Address |
1700 W WEST COVINA PKWY |
| City | WEST COVINA |
| State | CA |
| Zip Code | 91790-2706 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285279067 | Liang-wen Chen | Acupuncturist | 1433 West Merced Ave. Suite 304, West Covina, CA 91790 | 2019-11-15 |
| 1245880517 | Cheuk Man Chan | Acupuncturist | 1433 W Merced Ave., #309, West Covina, CA 91790 | 2019-09-18 |
| 1982174561 | Alexandra Isaacs | Marriage & Family Therapist | 1215 W. West Covina Pkwy., West Covina, CA 91790 | 2018-11-27 |
| 1568949709 | Lulua Zulfikarali Bahrainwala | Student in an Organized Health Care Education/Training Program | 1115 S Sunset Avenue #3940, West Covina, CA 91790 | 2018-07-20 |
| 1417442740 | Lydia Joy David | Nurse Practitioner | 1769 S Sunset Ave, West Covina, CA 91790 | 2018-06-28 |
| 1043721046 | Kimberly E Nevarez | Specialist/Technologist | 410 E Merced Ave Suite D, Suite D, West Covina, CA 91790 | 2017-10-17 |
| 1952825754 | Evan Lee Hendriks | Physician Assistant | 301 S Glendora Ave, Apt 2142, West Covina, CA 91790 | 2017-08-02 |
| 1669994588 | Meryl Francine Liu | Dentist | 1101 S. Glendora Ave #a, West Covina, CA 91790 | 2017-07-12 |
| 1326586330 | Athena Merianos | Marriage & Family Therapist | 1215 W. West Parkway, West Covina, CA 91790 | 2017-02-09 |
| 1912445990 | Lissette Bueno | Case Manager/Care Coordinator | 1517 West Garvey Ave North, West Covina, CA 91790 | 2017-02-09 |
| Find all providers in zip 91790 | ||||
| Taxonomy Code | 261QR0200X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Radiology |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184159899 | United Medical Radiology Network, Inc. | Clinic/Center | 1401 W Merced Ave, #102, West Covina, CA 91790-3401 | 2017-05-01 |
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| 1952924599 | Oracle Imaging Inc. | Clinic/Center | 6941 Brockton Ave, Riverside, CA 92506-3803 | 2020-05-18 |
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| 1982240321 | United Care Foundation | Clinic/Center | 2233 Watt Ave Ste 120, Sacramento, CA 95825-0569 | 2019-11-20 |
| 1932744893 | Westcoast Radiology Associates Pllc | Clinic/Center | 4193 Flat Rock Dr Ste 200, Riverside, CA 92505-7113 | 2019-11-14 |
| 1518502087 | Ishraf Corporation | Clinic/Center | 5720 Stoneridge Mall Rd Ste 288, Pleasanton, CA 94588-2830 | 2019-11-08 |
| 1780227769 | Drs Concepts, Incorporated | Clinic/Center | 9335 Reseda Blvd. Suite 102, Northridge, CA 91324 | 2019-10-23 |
| 1538700588 | Central Valley Medical Imaging, LLC | Clinic/Center | 1125 E Spruce Ave Ste 103, Fresno, CA 93720-3385 | 2019-10-01 |
| 1700447497 | Ester A Hanna | Clinic/Center | 72650 Fred Waring Dr Ste 107, Palm Desert, CA 92260-5007 | 2019-06-24 |
| Find all providers with the same taxonomy | ||||
| City | WEST COVINA |
| Zip Code | 91790 |
Please comment or provide details below to improve the information on CENTRELAKE MEDICAL GROUP INC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.