Healthcare Provider Details

I. General information

NPI: 1386581767
Provider Name (Legal Business Name): ANGELICA CENTENO-SHREDER MA, CCC-SLP, SLPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2026
Last Update Date: 05/02/2026
Certification Date: 05/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2310 ALDERGROVE AVE
ESCONDIDO CA
92029-1935
US

IV. Provider business mailing address

13446 MANGO DR
DEL MAR CA
92014-3537
US

V. Phone/Fax

Practice location:
  • Phone: 760-432-2400
  • Fax:
Mailing address:
  • Phone: 858-204-2757
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number12176
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: