Provider Demographics
NPI:1114296811
Name:CENTENO-COLON, RINA IVELISSE
Entity Type:Individual
Prefix:MRS
First Name:RINA
Middle Name:IVELISSE
Last Name:CENTENO-COLON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1530 CELEBRATION BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34747-5165
Mailing Address - Country:US
Mailing Address - Phone:321-939-2579
Mailing Address - Fax:321-939-2580
Practice Address - Street 1:1530 CELEBRATION BLVD STE 100
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34747-5165
Practice Address - Country:US
Practice Address - Phone:321-939-2579
Practice Address - Fax:321-939-2580
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-26
Last Update Date:2022-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR3722183500000X
FLPS38033183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist