Provider Demographics
NPI:1487871612
Name:CENTENO, MARTHA (RN)
Entity type:Individual
Prefix:MISS
First Name:MARTHA
Middle Name:
Last Name:CENTENO
Suffix:
Gender:F
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:PO BOX 355
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92702-0355
Mailing Address - Country:US
Mailing Address - Phone:714-562-1746
Mailing Address - Fax:714-562-1773
Practice Address - Street 1:1725 W 17TH ST
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92706-2316
Practice Address - Country:US
Practice Address - Phone:714-562-1746
Practice Address - Fax:714-562-1773
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA671721163W00000X
CA70987163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
No163W00000XNursing Service ProvidersRegistered Nurse