Healthcare Provider Details

I. General information

NPI: 1215216973
Provider Name (Legal Business Name): LLOYD CENTINO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2011
Last Update Date: 06/17/2021
Certification Date: 06/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BANNER DESERT MEDICAL CENTER ATTN HOSPITALIST 1400 S DOBSON RD
MESA AZ
85202
US

IV. Provider business mailing address

BANNER DESERT MEDICAL CENTER ATTN HOSPITALIST 1400 S DOBSON RD
MESA AZ
85202
US

V. Phone/Fax

Practice location:
  • Phone: 480-412-6788
  • Fax: 480-412-6848
Mailing address:
  • Phone: 480-412-6788
  • Fax: 480-412-6848

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number50392
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number50392
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: