Provider Demographics
NPI:1861266264
Name:CENTOFANTI, DIANA (DOM)
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:CENTOFANTI
Suffix:
Gender:F
Credentials:DOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 HARDEE CIR S
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-2408
Mailing Address - Country:US
Mailing Address - Phone:786-253-9119
Mailing Address - Fax:
Practice Address - Street 1:930 S HARBOR CITY BLVD STE 502
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-1967
Practice Address - Country:US
Practice Address - Phone:786-253-9119
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-07
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP4431171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist