Provider Demographics
NPI:1538296025
Name:CENTENO, JUANITA (RD ED D)
Entity Type:Individual
Prefix:DR
First Name:JUANITA
Middle Name:
Last Name:CENTENO
Suffix:
Gender:F
Credentials:RD ED D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:404 VEREDA DEL BOSQUE
Mailing Address - Street 2:
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00987-7154
Mailing Address - Country:US
Mailing Address - Phone:787-257-1019
Mailing Address - Fax:
Practice Address - Street 1:ING CGALINDE CPRSLOBBY TERRENOS CENTRO MEDICO
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00935-0001
Practice Address - Country:US
Practice Address - Phone:787-756-8529
Practice Address - Fax:787-756-8529
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR326133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered