Individual
MAURICIO ANTONIO CENTENO
Active
Individual
MAURICIO ANTONIO CENTENO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LSA
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
SA00481
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12678899
CAQH
TX
01
—
SA00481
SURGICAL ASSISTANT LICENSE
TX
Enumeration date
05/14/2011
Last updated
02/01/2020
Update your record
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