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General NPI Number Information
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NPI Number | 1194057901
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Entity Type | Organization
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Legal Business Name | CENIGENT HEALTH ENHANCEMENT MEDICAL INSTITUTE, A MEDICAL CORPORATION
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Dates
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Enumeration Date | 02/03/2010
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Last Update Date | 02/03/2010
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Provider Practice Location Address
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Address Line | 2222 SANTA MONICA BLVD SUITE 200
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City | SANTA MONICA
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State | CA
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Zip | 90404-2304
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Country | US
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Telephone | 310-998-8600
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Fax | 310-998-8662
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Provider Business Mailing Address
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Address Line | 2222 SANTA MONICA BLVD SUITE 200
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City | SANTA MONICA
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State | CA
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Zip | 90404-2304
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Country | US
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Telephone | 310-998-8600
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Fax | 310-998-8662
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. LIDA GHADERI
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Credential | M.D.
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Telephone | 310-998-8600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QG0250X
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Taxonomy Name | Genetics Clinic/Center
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License Number | A063230
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | A063230
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | A063230
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | A063230
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License Number State | CA
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