Provider Demographics
NPI:1518478098
Name:CENTENO, RAIZA (ARNP)
Entity Type:Individual
Prefix:
First Name:RAIZA
Middle Name:
Last Name:CENTENO
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:570 LEE DR
Mailing Address - Street 2:
Mailing Address - City:MIAMI SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33166-7207
Mailing Address - Country:US
Mailing Address - Phone:786-280-5881
Mailing Address - Fax:
Practice Address - Street 1:570 LEE DR
Practice Address - Street 2:
Practice Address - City:MIAMI SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33166-7207
Practice Address - Country:US
Practice Address - Phone:786-280-5881
Practice Address - Fax:786-280-5881
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-23
Last Update Date:2017-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9302321363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily