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General NPI Number Information
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NPI Number | 1013098532
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Entity Type | Organization
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Legal Business Name | CENTERVILLE MEDICAL GROUP AND ASSOCIATES, INC.
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Dates
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Enumeration Date | 10/18/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3778 BONDE WAY
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City | FREMONT
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State | CA
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Zip | 94536-3646
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Country | US
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Telephone | 510-818-9100
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Fax | 510-818-9901
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Provider Business Mailing Address
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Address Line | 3778 BONDE WAY
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City | FREMONT
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State | CA
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Zip | 94536-3646
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Country | US
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Telephone | 510-818-9100
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Fax | 510-818-9901
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. LENE V.M. MARTINEZ
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Credential | M.D.
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Telephone | 510-818-9100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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