Provider Demographics
NPI:1275068801
Name:CEN, MIN (APRN)
Entity Type:Individual
Prefix:MS
First Name:MIN
Middle Name:
Last Name:CEN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:81709 DR CARREON BLVD STE E1
Mailing Address - Street 2:
Mailing Address - City:INDIO
Mailing Address - State:CA
Mailing Address - Zip Code:92201-5589
Mailing Address - Country:US
Mailing Address - Phone:913-752-7002
Mailing Address - Fax:866-997-9757
Practice Address - Street 1:81709 DR CARREON BLVD STE E1
Practice Address - Street 2:
Practice Address - City:INDIO
Practice Address - State:CA
Practice Address - Zip Code:92201
Practice Address - Country:US
Practice Address - Phone:913-752-7002
Practice Address - Fax:866-997-9757
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-20
Last Update Date:2018-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS53-77553-111363L00000X
CANP95006537363LF0000X
CA95006537363LF0000X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily