Healthcare Provider Details

I. General information

NPI: 1730127515
Provider Name (Legal Business Name): BRIAN D. CARLOS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2006
Last Update Date: 12/08/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 SANTA FE DR SUITE 204
ENCINITAS CA
92024-5138
US

IV. Provider business mailing address

PO BOX 230757
ENCINITAS CA
92023-0757
US

V. Phone/Fax

Practice location:
  • Phone: 760-944-7300
  • Fax: 760-633-3949
Mailing address:
  • Phone: 760-944-7300
  • Fax: 760-633-3949

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberMD21044
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: