Healthcare Provider Details

I. General information

NPI: 1013196807
Provider Name (Legal Business Name): PRIME HEALTHCARE CENTINELA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/29/2007
Last Update Date: 10/29/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 N PRAIRIE AVE
INGLEWOOD CA
90301-4501
US

IV. Provider business mailing address

12479 CENTRAL AVE
CHINO CA
91710-2670
US

V. Phone/Fax

Practice location:
  • Phone: 310-680-1488
  • Fax: 310-677-0535
Mailing address:
  • Phone: 909-464-8847
  • Fax: 909-464-8887

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code273Y00000X
TaxonomyRehabilitation Hospital Unit
License Number
License Number StateCA

VIII. Authorized Official

Name: MICHAEL JOSEPH SARRAO
Title or Position: VICE-PRESIDENT & GENERAL COUNSEL
Credential:
Phone: 909-464-8847