Provider Demographics
NPI:1972681971
Name:EL SEGUNDO MEDICAL CENTER INC
Entity Type:Organization
Organization Name:EL SEGUNDO MEDICAL CENTER INC
Other - Org Name:CENTINELA MEDICAL CENTER EL SEGUNDO
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:MEDICAL DIRECTOR PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ARNOLD
Authorized Official - Middle Name:
Authorized Official - Last Name:CHANIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-322-1611
Mailing Address - Street 1:455 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:EL SEGUNDO
Mailing Address - State:CA
Mailing Address - Zip Code:90245
Mailing Address - Country:US
Mailing Address - Phone:310-322-1611
Mailing Address - Fax:310-322-4589
Practice Address - Street 1:455 MAIN STREET
Practice Address - Street 2:
Practice Address - City:EL SEGUNDO
Practice Address - State:CA
Practice Address - Zip Code:90245
Practice Address - Country:US
Practice Address - Phone:310-322-1611
Practice Address - Fax:310-322-4589
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22969261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ64726ZOtherBLUE SHIELD
CAGR0079113Medicaid
CAW18603Medicare ID - Type Unspecified
CAZZZ64726ZOtherBLUE SHIELD