Provider Demographics
NPI:1265831028
Name:CENTRO MEDICO PRACTICE INC
Entity Type:Organization
Organization Name:CENTRO MEDICO PRACTICE INC
Other - Org Name:CENTRO MEDICO EL MONTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:EUN IL
Authorized Official - Middle Name:
Authorized Official - Last Name:SHIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-448-7575
Mailing Address - Street 1:11920 GARVEY AVE
Mailing Address - Street 2:
Mailing Address - City:EL MONTE
Mailing Address - State:CA
Mailing Address - Zip Code:91732-3514
Mailing Address - Country:US
Mailing Address - Phone:626-448-7575
Mailing Address - Fax:626-448-8831
Practice Address - Street 1:11920 GARVEY AVE
Practice Address - Street 2:
Practice Address - City:EL MONTE
Practice Address - State:CA
Practice Address - Zip Code:91732-3514
Practice Address - Country:US
Practice Address - Phone:626-448-7575
Practice Address - Fax:626-448-8831
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-18
Last Update Date:2014-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty