Healthcare Provider Details

I. General information

NPI: 1336542869
Provider Name (Legal Business Name): CARLOS ADRIAN NEVAREZ ONTIVEROS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2014
Last Update Date: 04/26/2023
Certification Date: 04/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1150 N PALM CANYON DR
PALM SPRINGS CA
92262-4402
US

IV. Provider business mailing address

1150 N PALM CANYON DR
PALM SPRINGS CA
92262-4402
US

V. Phone/Fax

Practice location:
  • Phone: 415-623-4571
  • Fax:
Mailing address:
  • Phone: 415-623-4571
  • 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 StateNULL
# 2
Primary TaxonomyN
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number238.000403
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: