Healthcare Provider Details

I. General information

NPI: 1629762349
Provider Name (Legal Business Name): KAREL REYES BACARDI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2023
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8641 WILSHIRE BLVD STE 200
BEVERLY HILLS CA
90211-2920
US

IV. Provider business mailing address

6255 W SUNSET BLVD FL 21
LOS ANGELES CA
90028-7422
US

V. Phone/Fax

Practice location:
  • Phone: 310-657-9353
  • Fax: 833-687-1717
Mailing address:
  • Phone: 323-860-5200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number203586
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: