MEDICARE: MS. RAQUEL DEL CARMEN CENTENO LMT

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	225700000X	Massage Therapist	12291	CA

General Provider Information

NPI Number	:	1952031957
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. RAQUEL DEL CARMEN CENTENO LMT

Provider Business Mailing Address
First Line	:	4500 E 7TH ST APT 4
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90804-4394
Country	:	US
Telephone Number	:	310-381-9698
Fax Number	:

Provider Business Practice Location Address
First Line	:	244 MAIN ST
Second Line	:
City	:	SEAL BEACH
State	:	CA
Zip	:	90740-6318
Country	:	US
Telephone Number	:	310-381-9698
Fax Number	:

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

Provider Enumeration Date	:	06/13/2022
Last Update Date	:	06/13/2022

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