Provider Demographics
NPI:1760416366
Name:CHRISTOPHER J CENTENO, MD, PC
Entity Type:Organization
Organization Name:CHRISTOPHER J CENTENO, MD, PC
Other - Org Name:THE CENTENO CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:CENTENO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-429-6448
Mailing Address - Street 1:11080 CIRCLE POINT RD
Mailing Address - Street 2:BLDG 2, #140
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80020-2768
Mailing Address - Country:US
Mailing Address - Phone:303-429-6448
Mailing Address - Fax:303-429-6373
Practice Address - Street 1:11080 CIRCLE POINT RD
Practice Address - Street 2:BLDG 2, #140
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80020-2768
Practice Address - Country:US
Practice Address - Phone:303-429-6448
Practice Address - Fax:303-429-6373
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO33826207LP2900X
CO32265208VP0014X
CO1528363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
Not Answered208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
Not Answered363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO800266Medicare ID - Type UnspecifiedGROUP PRACTICE