Provider Demographics
NPI:1467584409
Name:CENTENO, JOSEPH DEAN (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:DEAN
Last Name:CENTENO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1206
Mailing Address - Street 2:
Mailing Address - City:GOLETA
Mailing Address - State:CA
Mailing Address - Zip Code:93116-1206
Mailing Address - Country:US
Mailing Address - Phone:805-964-3383
Mailing Address - Fax:805-683-3400
Practice Address - Street 1:316 S STRATFORD AVE
Practice Address - Street 2:SUITE C
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454-5908
Practice Address - Country:US
Practice Address - Phone:805-348-3700
Practice Address - Fax:805-683-3400
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2015-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA64528208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A645280Medicaid
CAH13217Medicare UPIN
CAWA64528CMedicare ID - Type Unspecified