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General NPI Number Information
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NPI Number | 1104293216
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Entity Type | Organization
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Legal Business Name | CENTRELAKE MEDICAL GROUP, INC.
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Dates
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Enumeration Date | 08/24/2015
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Last Update Date | 05/24/2021
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Provider Practice Location Address
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Address Line | 10226 LAKEWOOD BLVD
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City | DOWNEY
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State | CA
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Zip | 90241-2742
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Country | US
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Telephone | 562-287-7205
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Fax | 909-786-4391
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Provider Business Mailing Address
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Address Line | 3115 E GUASTI RD
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City | ONTARIO
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State | CA
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Zip | 91761-7853
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Country | US
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Telephone | 909-242-7300
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Fax | 909-786-4391
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Authorized Official
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Title or Position | OWNER
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Name | DR. ARVIND LAPSIWALA
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Credential | M.D.
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Telephone | 909-242-7300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0206X
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Taxonomy Name | Mammography Clinic/Center
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License Number | 282092
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 261QX0203X
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Taxonomy Name | Radiation Oncology Clinic/Center
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License Number | 282092
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 261QR0200X
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Taxonomy Name | Radiology Clinic/Center
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License Number | 282092
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License Number State | CA
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