Healthcare Provider Details

I. General information

NPI: 1700226669
Provider Name (Legal Business Name): GABRIEL CARPIO-BRACHO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2013
Last Update Date: 07/06/2022
Certification Date: 07/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3636 N 1ST ST STE 160
FRESNO CA
93726-6869
US

IV. Provider business mailing address

3636 N 1ST ST STE 160
FRESNO CA
93726-6869
US

V. Phone/Fax

Practice location:
  • Phone: 559-944-9298
  • Fax:
Mailing address:
  • Phone: 559-944-9298
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA141844
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number125.063987
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberA141844
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: