Basic Information
| Provider Information | |||||||||
| NPI: | 1932230661 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CENTENO | ||||||||
| FirstName: | VALERIE | ||||||||
| MiddleName: | GUADALUPE | ||||||||
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| Credential: | M.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 430 F ST | ||||||||
| Address2: | |||||||||
| City: | CHULA VISTA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 919103711 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6194203620 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1124 BAY BLVD STE D | ||||||||
| Address2: | |||||||||
| City: | CHULA VISTA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 919117155 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6194203620 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/07/2007 | ||||||||
| LastUpdateDate: | 01/18/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | 53734 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.