Healthcare Provider Details

I. General information

NPI: 1023737467
Provider Name (Legal Business Name): ANTHONY DICARLO RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2022
Last Update Date: 09/26/2022
Certification Date: 09/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 E 4TH ST
NATIONAL CITY CA
91950-2026
US

IV. Provider business mailing address

330 MOSS ST
CHULA VISTA CA
91911-2005
US

V. Phone/Fax

Practice location:
  • Phone: 619-470-4321
  • Fax:
Mailing address:
  • Phone: 619-585-4221
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95258790
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: