Provider Demographics
NPI:1114608825
Name:CENTENO, DIEGO (NP)
Entity Type:Individual
Prefix:
First Name:DIEGO
Middle Name:
Last Name:CENTENO
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1321 S BERKLEY ST
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92804-4608
Mailing Address - Country:US
Mailing Address - Phone:714-678-8984
Mailing Address - Fax:
Practice Address - Street 1:1321 S BERKLEY ST
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92804-4608
Practice Address - Country:US
Practice Address - Phone:714-678-8984
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-26
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA950257802084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry