Provider Demographics
NPI:1104293216
Name:CENTRELAKE MEDICAL GROUP, INC.
Entity type:Organization
Organization Name:CENTRELAKE MEDICAL GROUP, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ARVIND
Authorized Official - Middle Name:
Authorized Official - Last Name:LAPSIWALA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-242-7300
Mailing Address - Street 1:3115 E GUASTI RD
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91761-7853
Mailing Address - Country:US
Mailing Address - Phone:909-242-7300
Mailing Address - Fax:909-786-4391
Practice Address - Street 1:10226 LAKEWOOD BLVD
Practice Address - Street 2:
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90241-2742
Practice Address - Country:US
Practice Address - Phone:562-287-7205
Practice Address - Fax:909-786-4391
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-24
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA282092261QR0206X, 261QX0203X, 261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
No261QR0206XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mammography
No261QX0203XAmbulatory Health Care FacilitiesClinic/CenterOncology, Radiation