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General NPI Number Information
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NPI Number | 1861475352
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Entity Type | Organization
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Legal Business Name | CENTINELA RADIOLOGY MEDICAL GROUP
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Dates
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Enumeration Date | 11/29/2005
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Last Update Date | 08/15/2008
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Provider Practice Location Address
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Address Line | 555 E HARDY ST CENTINELA HOSPITAL MEDICAL CENTER
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City | INGLEWOOD
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State | CA
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Zip | 90301-4011
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Country | US
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Telephone | 310-673-4660
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 5686
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City | ORANGE
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State | CA
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Zip | 92863-5686
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Country | US
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Telephone | 888-598-8819
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Fax | 714-571-5055
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Authorized Official
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Title or Position | PARTNER
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Name | MICHAEL S SHAUB
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Credential | MD
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Telephone | 310-419-0597
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number |
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License Number State |
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