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General NPI Number Information
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NPI Number | 1154542967
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Entity Type | Individual
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Provider Name | GEOVANNIE MARCANO-CENTENO M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/01/2007
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Last Update Date | 07/03/2014
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Provider Practice Location Address
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Address Line | 1179 NW 166TH AVE PEMBROKE PINES
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City | PEMBROKE PINES
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State | FL
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Zip | 33028-1344
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Country | US
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Telephone | 754-400-8644
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Fax |
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Provider Business Mailing Address
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Address Line | 1179 NW 166TH AVE PEMBROKE PINES
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City | PEMBROKE PINES
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State | FL
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Zip | 33028-1344
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Country | US
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Telephone | 754-400-8644
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 282N00000X
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Taxonomy Name | General Acute Care Hospital
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License Number | 13887
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License Number State | PR
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Taxonomy #2
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | ME102854
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License Number State | FL
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