Healthcare Provider Details

I. General information

NPI: 1336753482
Provider Name (Legal Business Name): VIELKA D CENTENO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/06/2020
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13925 SW 106TH TER
MIAMI FL
33186-3138
US

IV. Provider business mailing address

13925 SW 106TH TER
MIAMI FL
33186-3138
US

V. Phone/Fax

Practice location:
  • Phone: 786-598-1554
  • Fax:
Mailing address:
  • Phone: 786-598-1554
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11003532
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: