Healthcare Provider Details

I. General information

NPI: 1083532667
Provider Name (Legal Business Name): CARLOS ISAAC RECINOS BERNABE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2026
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

747 52ND ST
OAKLAND CA
94609-1809
US

IV. Provider business mailing address

2120 GRANT ST APT 4
BERKELEY CA
94703-1564
US

V. Phone/Fax

Practice location:
  • Phone: 510-428-3885
  • Fax: 510-601-3913
Mailing address:
  • Phone: 626-893-3078
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: