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General NPI Number Information
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NPI Number | 1912219635
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Entity Type | Organization
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Legal Business Name | CENTINELA MEDICAL CENTER OF SOUTH BAY INC.
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Dates
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Enumeration Date | 07/10/2010
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Last Update Date | 03/31/2014
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Provider Practice Location Address
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Address Line | 1125 CHERRY AVE
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City | LONG BEACH
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State | CA
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Zip | 90813-3911
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Country | US
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Telephone | 562-591-1111
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1405
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City | LAWNDALE
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State | CA
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Zip | 90260-6305
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Country | US
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Telephone | 562-591-1111
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. JERRY A. OKONKWOAGUOLU
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Credential | MD, PHD
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Telephone | 562-591-1111
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QX0100X
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Taxonomy Name | Occupational Medicine Clinic/Center
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License Number | FNP40289
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number | FNP40289
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number | FNP40289
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License Number State | CA
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