Provider Demographics
NPI:1205172848
Name:CENTENO, JEFFREY PAUL (RN)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:PAUL
Last Name:CENTENO
Suffix:
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 1:7484 LARSEN BAY ST
Mailing Address - Street 2:
Mailing Address - City:EASTVALE
Mailing Address - State:CA
Mailing Address - Zip Code:92880-9197
Mailing Address - Country:US
Mailing Address - Phone:714-865-8418
Mailing Address - Fax:
Practice Address - Street 1:7484 LARSEN BAY ST
Practice Address - Street 2:
Practice Address - City:EASTVALE
Practice Address - State:CA
Practice Address - Zip Code:92880-9197
Practice Address - Country:US
Practice Address - Phone:714-865-8418
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-01
Last Update Date:2013-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA650182163WE0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WE0003XNursing Service ProvidersRegistered NurseEmergency