Individual
MAURICIO ANTONIO CENTENO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LSA
Contact information
Practice address
19026 STONE OAK PKWY STE 210B, SAN ANTONIO, TX 78258-3229
(210) 606-8213
(210) 491-1349
Mailing address
19026 STONE OAK PKWY STE 210B, SAN ANTONIO, TX 78258-3229
(210) 606-8213
(210) 491-1349
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
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