Healthcare Provider Details

I. General information

NPI: 1750339990
Provider Name (Legal Business Name): CHRISTOPHER J CENTENO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 08/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

403 SUMMIT BLVD SUITE 201
BROOMFIELD CO
80021
US

IV. Provider business mailing address

403 SUMMIT BLVD SUITE 201
BROOMFIELD CO
80021
US

V. Phone/Fax

Practice location:
  • Phone: 303-429-6448
  • Fax: 303-951-3701
Mailing address:
  • Phone: 303-429-6448
  • Fax: 303-951-3701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number32265
License Number StateCO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: