Provider Demographics
NPI:1053893636
Name:CENTENO, SIDNEY JOHANNA (LIFESTYLE COACH)
Entity type:Individual
Prefix:MS
First Name:SIDNEY
Middle Name:JOHANNA
Last Name:CENTENO
Suffix:
Gender:F
Credentials:LIFESTYLE COACH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8190 S JOG RD STE 120
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33472-2911
Mailing Address - Country:US
Mailing Address - Phone:561-964-1411
Mailing Address - Fax:561-964-3039
Practice Address - Street 1:8190 S JOG RD STE 120
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33472-2911
Practice Address - Country:US
Practice Address - Phone:561-964-1411
Practice Address - Fax:561-964-3039
Is Sole Proprietor?:No
Enumeration Date:2018-08-30
Last Update Date:2018-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator