Healthcare Provider Details

I. General information

NPI: 1184035032
Provider Name (Legal Business Name): CARLOS BEHARIE M.D. MEDICAL GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2014
Last Update Date: 06/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4160 N. MAINE AVE, SUITE B1, B2, B3
BALDWIN PARK CA
91706-3304
US

IV. Provider business mailing address

4160 MAINE AVE STE B1B2B3
BALDWIN PARK CA
91706-3304
US

V. Phone/Fax

Practice location:
  • Phone: 626-653-0800
  • Fax: 626-244-0485
Mailing address:
  • Phone: 626-653-0800
  • Fax: 626-244-0485

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number
License Number StateCA

VIII. Authorized Official

Name: JAMIE BOJORQUEZ
Title or Position: OFFICE MANAGER
Credential:
Phone: 626-652-0790