Basic Information
| Provider Information | |||||||||
| NPI: | 1306517230 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CENTENO | ||||||||
| FirstName: | LANI MAY | ||||||||
| MiddleName: | AQUINO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 20 S STONE AVE APT 415 | ||||||||
| Address2: | |||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857010005 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8315218812 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3601 S 6TH AVE | ||||||||
| Address2: | |||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857230001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5206294606 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/21/2021 | ||||||||
| LastUpdateDate: | 10/07/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/07/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | 34953 | CA | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 152W00000X | 34953 | CA | Y | Eye and Vision Services Providers | Optometrist |
No ID Information.