Provider Demographics
NPI:1871219063
Name:CENTENO DURAN, GEORGINA ALEJANDRA (MD)
Entity type:Individual
Prefix:
First Name:GEORGINA
Middle Name:ALEJANDRA
Last Name:CENTENO DURAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 PLAZA CIR
Mailing Address - Street 2:
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93901-2952
Mailing Address - Country:US
Mailing Address - Phone:831-757-8689
Mailing Address - Fax:
Practice Address - Street 1:122 E SAN ANTONIO DR
Practice Address - Street 2:
Practice Address - City:KING CITY
Practice Address - State:CA
Practice Address - Zip Code:93930-2518
Practice Address - Country:US
Practice Address - Phone:831-385-5944
Practice Address - Fax:831-385-8618
Is Sole Proprietor?:No
Enumeration Date:2022-10-18
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAP14207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology