Healthcare Provider Details

I. General information

NPI: 1639591407
Provider Name (Legal Business Name): CARLO P. HONRADO, M.D., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/14/2014
Last Update Date: 01/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2080 CENTURY PARK E 1700
LOS ANGELES CA
90067-2001
US

IV. Provider business mailing address

2080 CENTURY PARK E 1700
LOS ANGELES CA
90067-2001
US

V. Phone/Fax

Practice location:
  • Phone: 310-201-0717
  • Fax: 310-201-9665
Mailing address:
  • Phone: 310-201-0717
  • Fax: 310-201-9665

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License NumberA102560
License Number StateCA

VIII. Authorized Official

Name: DR. CARLO P HONRADO
Title or Position: OWNER
Credential: M.D.
Phone: 310-201-0717