Most Relevant Information
Provider Data
| NPI Number: | 1003563008 |
| Provider Name: | NADINE CENTENO MIRANDA LUIS |
| Entity Type: | Individual |
| Taxonomy Code: | 171M00000X |
| Specialty: | Case Manager/Care Coordinator |
| License Number: |
Most Important Dates
| Enumeration Date: | 03/09/2022 |
| Last Updated: | 03/09/2022 |
Provider Practice Location
1610 5TH ST
SAN FERNANDO
CA
913402013
Practice Location Phone/Fax
| Phone: | 8185212512 |
| Fax: |
Provider Mailing Location
8337 TELEGRAPH RD STE 115
PICO RIVERA
CA
906604940
Provider Mailing Phone/Fax
| Phone: | 5626193501 |
| Fax: |