Healthcare Provider Details

I. General information

NPI: 1477509917
Provider Name (Legal Business Name): BYRON F CARCELEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 12/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 W I ST
LOS BANOS CA
93635-3419
US

IV. Provider business mailing address

631 S SHELTON ST #D
BURBANK CA
91506-3156
US

V. Phone/Fax

Practice location:
  • Phone: 209-826-0591
  • Fax:
Mailing address:
  • Phone: 818-434-8554
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberG79516
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberG79516
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: