Provider Demographics
NPI:1144770991
Name:CENTENO, MAYRA ALEJANDRA (MFT-I)
Entity Type:Individual
Prefix:MRS
First Name:MAYRA
Middle Name:ALEJANDRA
Last Name:CENTENO
Suffix:
Gender:F
Credentials:MFT-I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2594 INDUSTRY WAY
Mailing Address - Street 2:
Mailing Address - City:LYNWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90262-4015
Mailing Address - Country:US
Mailing Address - Phone:310-667-4070
Mailing Address - Fax:310-667-4068
Practice Address - Street 1:2594 INDUSTRY WAY
Practice Address - Street 2:
Practice Address - City:LYNWOOD
Practice Address - State:CA
Practice Address - Zip Code:90262-4015
Practice Address - Country:US
Practice Address - Phone:310-667-4070
Practice Address - Fax:310-667-4068
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-05
Last Update Date:2016-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA80181106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist