Provider Demographics
NPI:1356401160
Name:CENTOC MEDICAL GROUP INC
Entity type:Organization
Organization Name:CENTOC MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERTO
Authorized Official - Middle Name:
Authorized Official - Last Name:BARRETTO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-633-4020
Mailing Address - Street 1:27401 LOS ALTOS
Mailing Address - Street 2:SUITE 180
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-6316
Mailing Address - Country:US
Mailing Address - Phone:949-582-9624
Mailing Address - Fax:949-582-9626
Practice Address - Street 1:1201 W LA VETA AVE
Practice Address - Street 2:SUITE 604
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-4213
Practice Address - Country:US
Practice Address - Phone:714-633-4020
Practice Address - Fax:714-633-4846
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2007-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0103190Medicaid
CAGR0103190Medicaid