MEDICARE: DESERT COAST PSYCHIATRY AND WELLNESS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician

General Provider Information

NPI Number	:	1639026479
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DESERT COAST PSYCHIATRY AND WELLNESS

Provider Business Mailing Address
First Line	:	10601 WALKER ST FL 1
Second Line	:
City	:	CYPRESS
State	:	CA
Zip	:	90630-4733
Country	:	US
Telephone Number	:	619-612-7142
Fax Number	:

Provider Business Practice Location Address
First Line	:	10601 WALKER ST FL 1
Second Line	:
City	:	CYPRESS
State	:	CA
Zip	:	90630-4733
Country	:	US
Telephone Number	:	619-612-7142
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	DIEGO CENTENO
Credential	:	NP
Telephone Number	:	714-678-8984

Provider Enumeration Date	:	03/11/2026
Last Update Date	:	03/11/2026

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