Provider Demographics
NPI:1336231059
Name:CENTINELA VALLEY ENDOSCOPY CENTER INC.
Entity Type:Organization
Organization Name:CENTINELA VALLEY ENDOSCOPY CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:A
Authorized Official - Last Name:FRANKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-330-9900
Mailing Address - Street 1:575 E HARDY ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90301-4036
Mailing Address - Country:US
Mailing Address - Phone:310-680-6850
Mailing Address - Fax:310-330-8638
Practice Address - Street 1:575 E HARDY ST
Practice Address - Street 2:SUITE 101
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90301-4036
Practice Address - Country:US
Practice Address - Phone:310-680-6850
Practice Address - Fax:310-330-8638
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-29
Last Update Date:2015-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASUR01693FMedicaid
CAS051693Medicare PIN
CAP00309522Medicare PIN