Healthcare Provider Details

I. General information

NPI: 1265053821
Provider Name (Legal Business Name): PETER GREG CENTENO MACARANAS CRT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2020
Last Update Date: 05/05/2020
Certification Date: 05/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11810 SATICOY ST
NORTH HOLLYWOOD CA
91605-2848
US

IV. Provider business mailing address

7845 HAZELTINE AVE
PANORAMA CITY CA
91402-5211
US

V. Phone/Fax

Practice location:
  • Phone: 818-982-4600
  • Fax:
Mailing address:
  • Phone: 818-808-7506
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code227800000X
TaxonomyCertified Respiratory Therapist
License Number32281
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2278G1100X
TaxonomyGeneral Care Certified Respiratory Therapist
License Number32281
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code2278P3900X
TaxonomyNeonatal/Pediatric Certified Respiratory Therapist
License Number32281
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: