Provider Demographics
NPI:1821550989
Name:CENTENO, ANDRES JR (RN)
Entity Type:Individual
Prefix:
First Name:ANDRES
Middle Name:
Last Name:CENTENO
Suffix:JR
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9333 LOCH LOMOND DR
Mailing Address - Street 2:
Mailing Address - City:PICO RIVERA
Mailing Address - State:CA
Mailing Address - Zip Code:90660-2913
Mailing Address - Country:US
Mailing Address - Phone:562-801-7550
Mailing Address - Fax:
Practice Address - Street 1:9333 LOCH LOMOND DR
Practice Address - Street 2:
Practice Address - City:PICO RIVERA
Practice Address - State:CA
Practice Address - Zip Code:90660-2913
Practice Address - Country:US
Practice Address - Phone:562-801-7550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-05
Last Update Date:2019-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA534584163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool