Healthcare Provider Details

I. General information

NPI: 1124086137
Provider Name (Legal Business Name): JOSEPH MICHAEL CENTENO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2006
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

499 DEVLIN RD
NAPA CA
94558-6274
US

IV. Provider business mailing address

499 DEVLIN RD
NAPA CA
94558-6274
US

V. Phone/Fax

Practice location:
  • Phone: 707-645-7210
  • Fax: 707-645-7249
Mailing address:
  • Phone: 707-645-7210
  • Fax: 707-645-7249

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberA77447
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: