Healthcare Provider Details

I. General information

NPI: 1447181763
Provider Name (Legal Business Name): CENTENO-CISNEROS MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2026
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 NW 15TH ST
HOMESTEAD FL
33030-3958
US

IV. Provider business mailing address

1300 NW 15TH ST
HOMESTEAD FL
33030-3958
US

V. Phone/Fax

Practice location:
  • Phone: 305-283-3495
  • Fax:
Mailing address:
  • Phone: 305-283-3495
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DIANA CENTENO
Title or Position: PROVIDER/OWNER
Credential: APRN
Phone: 305-283-3495