Provider Demographics
NPI:1841015518
Name:CENTENO, GIANCARLO GARCIA
Entity type:Individual
Prefix:
First Name:GIANCARLO
Middle Name:GARCIA
Last Name:CENTENO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 253
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94701-0253
Mailing Address - Country:US
Mailing Address - Phone:415-732-5608
Mailing Address - Fax:415-732-0345
Practice Address - Street 1:22 BATTERY ST STE 888
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94111-5522
Practice Address - Country:US
Practice Address - Phone:415-732-5608
Practice Address - Fax:415-732-0345
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-18
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA307098225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty