Provider Demographics
NPI:1295369791
Name:CENTRO MEDICO GENERAL, INC.
Entity Type:Organization
Organization Name:CENTRO MEDICO GENERAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:DIEGO
Authorized Official - Middle Name:IVAN
Authorized Official - Last Name:KRIGER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:951-822-7191
Mailing Address - Street 1:2090 S EUCLID ST
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92802-3143
Mailing Address - Country:US
Mailing Address - Phone:714-539-2200
Mailing Address - Fax:
Practice Address - Street 1:2090 S EUCLID ST
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92802-3143
Practice Address - Country:US
Practice Address - Phone:714-539-2200
Practice Address - Fax:714-539-2277
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-24
Last Update Date:2020-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty