Healthcare Provider Details

I. General information

NPI: 1366409922
Provider Name (Legal Business Name): SARAH MARIE CENTENO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/27/2006
Last Update Date: 02/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1030 SIR FRANCIS DRAKE BLVD SUITE 100, RM 1
KENTFIELD CA
94904-1411
US

IV. Provider business mailing address

1030 SIR FRANCIS DRAKE BLVD SUITE 100, RM 1
KENTFIELD CA
94904-1411
US

V. Phone/Fax

Practice location:
  • Phone: 415-927-7097
  • Fax: 415-449-3532
Mailing address:
  • Phone: 415-927-7097
  • Fax: 415-449-3532

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD20050147
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: