Provider Demographics
NPI:1972121218
Name:CENTIA HEALTH LLC
Entity Type:Organization
Organization Name:CENTIA HEALTH LLC
Other - Org Name:CENTIA HEALTH LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FOUNDER, CHIEF MEDICAL OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:SOSUNMOLU
Authorized Official - Middle Name:OPEYEMI
Authorized Official - Last Name:SHOYINKA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:236-842-4328
Mailing Address - Street 1:11225 N 28TH DR STE D220B
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85029-5697
Mailing Address - Country:US
Mailing Address - Phone:623-518-1025
Mailing Address - Fax:623-666-6655
Practice Address - Street 1:11225 N 28TH DR STE D220B
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85029-5697
Practice Address - Country:US
Practice Address - Phone:623-518-1025
Practice Address - Fax:623-666-6655
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-13
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
550OtherNONE