Healthcare Provider Details

I. General information

NPI: 1134493463
Provider Name (Legal Business Name): CENTINELA HOSPITAL MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2012
Last Update Date: 03/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 SOUTH RENO ST UNIT 347
LOS ANGELES CA
90057
US

IV. Provider business mailing address

120 S RENO ST APT 347
LOS ANGELES CA
90057-5500
US

V. Phone/Fax

Practice location:
  • Phone: 213-249-6884
  • Fax:
Mailing address:
  • Phone: 213-249-6884
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code282E00000X
TaxonomyLong Term Care Hospital
License Number773088
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number773088
License Number StateCA

VIII. Authorized Official

Name: MRS. MARIA ALANIS
Title or Position: CHARGE NURSE
Credential: RN
Phone: 310-419-8685