Healthcare Provider Details

I. General information

NPI: 1124858014
Provider Name (Legal Business Name): PHILIP MAXWELL CARO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2024
Last Update Date: 11/05/2026
Certification Date: 11/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 S LOS ROBLES AVE # 501
PASADENA CA
91101-2453
US

IV. Provider business mailing address

1130 HUNTINGTON DR UNIT B
SOUTH PASADENA CA
91030-4571
US

V. Phone/Fax

Practice location:
  • Phone: 626-564-3016
  • Fax:
Mailing address:
  • Phone: 615-397-0152
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95316254
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number95003014
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number984022
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: