Healthcare Provider Details

I. General information

NPI: 1316227192
Provider Name (Legal Business Name): ERNESTO J CENTENO M.S., L.P.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2011
Last Update Date: 02/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

929 MANOR DR 10
SAN ANTONIO TX
78228-3267
US

IV. Provider business mailing address

9518 MAJESTIC OAK CIRCLE
SAN ANTONIO TX
78255
US

V. Phone/Fax

Practice location:
  • Phone: 210-827-1628
  • Fax:
Mailing address:
  • Phone: 210-827-1628
  • Fax: 888-977-3414

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number4849
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code103TR0400X
TaxonomyRehabilitation Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: