Provider Demographics
NPI:1659513091
Name:CENTENO, ROUBINA (MS)
Entity Type:Individual
Prefix:MS
First Name:ROUBINA
Middle Name:
Last Name:CENTENO
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4900 1/2 BELL AVE
Mailing Address - Street 2:
Mailing Address - City:BELL
Mailing Address - State:CA
Mailing Address - Zip Code:90201-4996
Mailing Address - Country:US
Mailing Address - Phone:818-482-8338
Mailing Address - Fax:
Practice Address - Street 1:5150 E PACIFIC COAST HWY STE 200
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90804-3399
Practice Address - Country:US
Practice Address - Phone:818-482-8338
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-31
Last Update Date:2019-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA77171106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist