Provider Demographics
NPI:1912547357
Name:CENTRO CLINICO LLC
Entity Type:Organization
Organization Name:CENTRO CLINICO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DENIA
Authorized Official - Middle Name:
Authorized Official - Last Name:PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:973-341-3782
Mailing Address - Street 1:32 HINE ST STE 103
Mailing Address - Street 2:
Mailing Address - City:PATERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07503-2955
Mailing Address - Country:US
Mailing Address - Phone:973-341-3782
Mailing Address - Fax:973-341-3783
Practice Address - Street 1:32 HINE ST STE 103
Practice Address - Street 2:
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07503-2955
Practice Address - Country:US
Practice Address - Phone:973-341-3782
Practice Address - Fax:973-341-3783
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-14
Last Update Date:2020-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Multi-Specialty
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Multi-Specialty