Provider Demographics
NPI:1750339990
Name:CENTENO, CHRISTOPHER J (MD)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:J
Last Name:CENTENO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:403 SUMMIT BLVD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80021
Mailing Address - Country:US
Mailing Address - Phone:303-429-6448
Mailing Address - Fax:303-951-3701
Practice Address - Street 1:403 SUMMIT BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80021
Practice Address - Country:US
Practice Address - Phone:303-429-6448
Practice Address - Fax:303-951-3701
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2010-08-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO32265208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO803963Medicare ID - Type Unspecified
COE73265Medicare UPIN
COC803963Medicare PIN