Healthcare Provider Details

I. General information

NPI: 1962539684
Provider Name (Legal Business Name): CENTINELA FREEMAN EMERGENCY MEDICAL ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2007
Last Update Date: 02/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 E HARDY ST
INGLEWOOD CA
90301-4011
US

IV. Provider business mailing address

PO BOX 661297
ARCADIA CA
91066-1297
US

V. Phone/Fax

Practice location:
  • Phone: 310-419-8636
  • Fax: 310-963-0403
Mailing address:
  • Phone: 626-447-0296
  • Fax: 626-447-6036

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number StateCA

VIII. Authorized Official

Name: DR. IRV EDWARDS
Title or Position: MANAGING PARTNER
Credential: M.D.
Phone: 310-379-2134