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NPI Code Detail

MEDICARE: CENTINELA MEDICAL CENTER OF SOUTH BAY INC.

MEDICARE: CENTINELA MEDICAL CENTER OF SOUTH BAY INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QX0100XOccupational Medicine Clinic/CenterFNP40289CA
2261QU0200XUrgent Care Clinic/CenterFNP40289CA
3261QM1300XMulti-Specialty Clinic/CenterFNP40289CA

General Provider Information

NPI Number : 1912219635
Entity Type Code : Organization
Provider Name (Legal Business Name) : CENTINELA MEDICAL CENTER OF SOUTH BAY INC.
Provider Business Mailing Address
First Line : PO BOX 1405
Second Line :
City : LAWNDALE
State : CA
Zip : 90260-6305
Country : US
Telephone Number : 562-591-1111
Fax Number :
Provider Business Practice Location Address
First Line : 1125 CHERRY AVE
Second Line :
City : LONG BEACH
State : CA
Zip : 90813-3911
Country : US
Telephone Number : 562-591-1111
Fax Number :
Authorized Official
Title or Position : MEDICAL DIRECTOR
Name : DR. JERRY A. OKONKWOAGUOLU
Credential : MD, PHD
Telephone Number : 562-591-1111
Provider Enumeration Date : 07/10/2010
Last Update Date : 03/31/2014

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Directions to “CENTINELA MEDICAL CENTER OF SOUTH BAY INC. ” Practice Location

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