Healthcare Provider Details

I. General information

NPI: 1053590844
Provider Name (Legal Business Name): CARLOS INFANTE ROBLES PHARMACIST
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/29/2007
Last Update Date: 10/29/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1550 SUPERIOR AVE
COSTA MESA CA
92627-3653
US

IV. Provider business mailing address

2218 GRANGER AVE
NATIONAL CITY CA
91950-6210
US

V. Phone/Fax

Practice location:
  • Phone: 949-650-0640
  • Fax:
Mailing address:
  • Phone: 619-495-8430
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number35836
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: