Provider Demographics
NPI:1992183602
Name:CENTERLINE DIAGNOSTICS
Entity Type:Organization
Organization Name:CENTERLINE DIAGNOSTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SANJIVAN
Authorized Official - Middle Name:SINGH
Authorized Official - Last Name:KOHLI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-954-9511
Mailing Address - Street 1:154 W FOOTHILL BLVD
Mailing Address - Street 2:SUITE#518
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-8702
Mailing Address - Country:US
Mailing Address - Phone:310-954-9511
Mailing Address - Fax:310-817-6364
Practice Address - Street 1:154 W FOOTHILL BLVD
Practice Address - Street 2:SUITE#518
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-8702
Practice Address - Country:US
Practice Address - Phone:310-954-9511
Practice Address - Fax:310-817-6364
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-13
Last Update Date:2015-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA109968207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty