MEDICARE: DR. SANTIAGO ALBERTO CENTURION M.D.

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	207N00000X	Dermatology Physician	25MA07649600	NJ
2	207N00000X	Dermatology Physician	A866380	CA
3	207ND0900X	Dermatopathology Physician	A866380	CA
4	207ND0101X	MOHS-Micrographic Surgery Physician	A866380	CA
5	207N00000X	Dermatology Physician	231911-1	NY
6	207ND0900X	Dermatopathology Physician	231911-1	NY
7	207ND0101X	MOHS-Micrographic Surgery Physician	231911-1	NY
8	207ND0900X	Dermatopathology Physician	25MA07649600	NJ
9	207ND0101X	MOHS-Micrographic Surgery Physician	25MA07649600	NJ

General Provider Information

NPI Number	:	1710099585
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SANTIAGO ALBERTO CENTURION M.D.

Provider Business Mailing Address
First Line	:	106 LYNCH CREEK WAY
Second Line	:	SUITE 8
City	:	PETALUMA
State	:	CA
Zip	:	94954-2356
Country	:	US
Telephone Number	:	707-763-6816
Fax Number	:	707-763-1730

Provider Business Practice Location Address
First Line	:	106 LYNCH CREEK WAY
Second Line	:	SUITE 8
City	:	PETALUMA
State	:	CA
Zip	:	94954-2356
Country	:	US
Telephone Number	:	707-763-6816
Fax Number	:	707-763-1730

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

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	02/24/2011

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