MEDICARE: LAUREN CENTRELLA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	0506359	NV

General Provider Information

NPI Number	:	1396127007
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAUREN CENTRELLA

Provider Business Mailing Address
First Line	:	11583 GLOWING SUNSET LN
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89135-1657
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	11583 GLOWING SUNSET LN
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89135-1657
Country	:	US
Telephone Number	:	702-302-7889
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/18/2015
Last Update Date	:	06/18/2015

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Directions to “ LAUREN CENTRELLA ” Practice Location

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