MEDICARE: MS. ROUBINA CENTENO M.S.

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	106H00000X	Marriage & Family Therapist	77171	CA

General Provider Information

NPI Number	:	1659513091
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ROUBINA CENTENO M.S.

Provider Business Mailing Address
First Line	:	4900 1/2 BELL AVE
Second Line	:
City	:	BELL
State	:	CA
Zip	:	90201-4996
Country	:	US
Telephone Number	:	818-482-8338
Fax Number	:

Provider Business Practice Location Address
First Line	:	5150 E PACIFIC COAST HWY STE 200
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90804-3399
Country	:	US
Telephone Number	:	818-482-8338
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/31/2009
Last Update Date	:	12/09/2019

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