Healthcare Provider Details

I. General information

NPI: 1821946401
Provider Name (Legal Business Name): CARLO TAMPOS NP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/19/2026
Last Update Date: 03/19/2026
Certification Date: 03/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 641519
LOS ANGELES CA
90064-6519
US

IV. Provider business mailing address

16750 SHERMAN WAY APT 213
LAKE BALBOA CA
91406-3745
US

V. Phone/Fax

Practice location:
  • Phone: 833-379-6863
  • Fax:
Mailing address:
  • Phone: 424-200-8627
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95037694
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: