Provider Demographics
NPI:1366409922
Name:CENTENO, SARAH MARIE (MD)
Entity type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:MARIE
Last Name:CENTENO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1030 SIR FRANCIS DRAKE BLVD
Mailing Address - Street 2:SUITE 100, RM 1
Mailing Address - City:KENTFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94904-1411
Mailing Address - Country:US
Mailing Address - Phone:415-927-7097
Mailing Address - Fax:415-449-3532
Practice Address - Street 1:1030 SIR FRANCIS DRAKE BLVD
Practice Address - Street 2:SUITE 100, RM 1
Practice Address - City:KENTFIELD
Practice Address - State:CA
Practice Address - Zip Code:94904-1411
Practice Address - Country:US
Practice Address - Phone:415-927-7097
Practice Address - Fax:415-449-3532
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-27
Last Update Date:2015-02-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NMMD200501472084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM33655731Medicaid
I37789Medicare UPIN
344523603Medicare ID - Type Unspecified