Provider Demographics
NPI:1497776322
Name:CENTRO MEDICO INC.
Entity Type:Organization
Organization Name:CENTRO MEDICO INC.
Other - Org Name:CENTRO MEDICO, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:NABIL
Authorized Official - Middle Name:NAZIR
Authorized Official - Last Name:SOLIMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-675-1136
Mailing Address - Street 1:11946 HAWTHORNE BLVD.
Mailing Address - Street 2:
Mailing Address - City:HAWTHORNE
Mailing Address - State:CA
Mailing Address - Zip Code:90250-3016
Mailing Address - Country:US
Mailing Address - Phone:310-675-1136
Mailing Address - Fax:310-970-1447
Practice Address - Street 1:11946 HAWTHORNE BLVD.
Practice Address - Street 2:
Practice Address - City:HAWTHORNE
Practice Address - State:CA
Practice Address - Zip Code:90250-3016
Practice Address - Country:US
Practice Address - Phone:310-675-1136
Practice Address - Fax:310-970-1447
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-23
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0057390Medicaid
CAZZZ39006ZOtherBLUE SHIELD PROVIDER #