Healthcare Provider Details

I. General information

NPI: 1477786473
Provider Name (Legal Business Name): CENTROSALUD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2009
Last Update Date: 08/25/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 KIRBY ROAD SUITE #11
MEMPHIS TN
38119
US

IV. Provider business mailing address

2900 KIRBY ROAD SUITE #11
MEMPHIS TN
38119
US

V. Phone/Fax

Practice location:
  • Phone: 901-737-7393
  • Fax: 901-737-2696
Mailing address:
  • Phone: 901-737-7393
  • Fax: 901-737-2696

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2080P0006X
TaxonomyDevelopmental - Behavioral Pediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: CLAUDIA L FLORES
Title or Position: CLINIC MANAGER
Credential:
Phone: 901-531-8800