Healthcare Provider Details

I. General information

NPI: 1912547357
Provider Name (Legal Business Name): CENTRO CLINICO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/14/2020
Last Update Date: 02/11/2020
Certification Date: 02/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32 HINE ST STE 103
PATERSON NJ
07503-2955
US

IV. Provider business mailing address

32 HINE ST STE 103
PATERSON NJ
07503-2955
US

V. Phone/Fax

Practice location:
  • Phone: 973-341-3782
  • Fax: 973-341-3783
Mailing address:
  • Phone: 973-341-3782
  • Fax: 973-341-3783

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DENIA PEREZ
Title or Position: OWNER
Credential: NP
Phone: 973-341-3782