Healthcare Provider Details

I. General information

NPI: 1215193297
Provider Name (Legal Business Name): CARLOS R DUARTE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2008
Last Update Date: 08/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5901 E 7TH ST PROSTHETICS
LONG BEACH CA
90822-5201
US

IV. Provider business mailing address

11111 ELM ST
LYNWOOD CA
90262-2905
US

V. Phone/Fax

Practice location:
  • Phone: 562-826-8000
  • Fax:
Mailing address:
  • Phone: 310-902-5162
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225000000X
TaxonomyOrthotic Fitter
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: