MEDICARE: MA KARIM CARBAJAL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	164X00000X	Licensed Vocational Nurse	732090	CA

General Provider Information

NPI Number	:	1215869326
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MA KARIM CARBAJAL

Provider Business Mailing Address
First Line	:	2113 ROCKEFELLER LN APT C
Second Line	:
City	:	REDONDO BEACH
State	:	CA
Zip	:	90278-3692
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	505 S PACIFIC AVE
Second Line	:
City	:	SAN PEDRO
State	:	CA
Zip	:	90731-2656
Country	:	US
Telephone Number	:	310-519-8723
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/02/2026
Last Update Date	:	06/02/2026

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Directions to “ MA KARIM CARBAJAL ” Practice Location

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