Healthcare Provider Details

I. General information

NPI: 1508173667
Provider Name (Legal Business Name): MR. HUGO CENTENO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2010
Last Update Date: 02/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1320 S F ST
OXNARD CA
93033-3136
US

IV. Provider business mailing address

1320 S F ST
OXNARD CA
93033-3136
US

V. Phone/Fax

Practice location:
  • Phone: 805-236-6298
  • Fax:
Mailing address:
  • Phone: 805-236-6298
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW80383
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: