Healthcare Provider Details

I. General information

NPI: 1730593708
Provider Name (Legal Business Name): ALEJANDRO JOSE CENTURION MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2014
Last Update Date: 06/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15955 SW 96TH ST STE 401
MIAMI FL
33196
US

IV. Provider business mailing address

15955 SW 96TH ST STE 401
MIAMI FL
33196-1273
US

V. Phone/Fax

Practice location:
  • Phone: 786-268-6200
  • Fax:
Mailing address:
  • Phone: 786-268-6200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberTRN25256
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberME135790
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: