Centinela Valley Ipa Medical Group | San Dimas, CA • PECOS Search

Centinela Valley Ipa Medical Group

Contractor

Other Service Providers

955 Overland Ct Fl 2, San Dimas, CA 91773-1718

PECOS Enrollment

Based on the most recent information from CMS, provider Centinela Valley Ipa Medical Group does not have current enrollment records in PECOS.

Part B
Medicare Part B
Not Enrolled
HHA
Home Health Agency
Not Enrolled
DME
Durable Medical Equipment
Not Enrolled
PMD
Power Mobility Device
Not Enrolled

CMS last updated its PECOS records yesterday at 4:18 PM.

Profile Details

Provider ID
1164552378
Provider Type
Organization
Full Name
Centinela Valley Ipa Medical Group

Subpart
No
Enumeration Date
3/6/2007
Last Updated
8/22/2020

Contact Information

Practice Location

955 Overland Ct Fl 2, San Dimas, CA 91773-1718

Unlisted Fax

Mailing Location

PO Box 4069, Covina, CA 91723-0469

Unlisted Fax

Authorized Official

Mitchell, Anitha (President)

Provider Taxonomies

Code	Description	License
Code 171W00000X Primary	Description Contractor Other Service Providers	License 171W00000X California