Healthcare Provider Details

I. General information

NPI: 1003081951
Provider Name (Legal Business Name): CARLOS GARCES CPO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2008
Last Update Date: 02/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10339 ZELZAH AVE APT 21
NORTHRIDGE CA
91326-3540
US

IV. Provider business mailing address

10339 ZELZAH AVE APT 21
NORTHRIDGE CA
91326-3540
US

V. Phone/Fax

Practice location:
  • Phone: 818-300-3872
  • Fax:
Mailing address:
  • Phone: 818-300-3872
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225000000X
TaxonomyOrthotic Fitter
License NumberC16152
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code1744P3200X
TaxonomyProsthetics Case Management
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: