Healthcare Provider Details

I. General information

NPI: 1619448214
Provider Name (Legal Business Name): JONATHAN T CARPIO RCP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2018
Last Update Date: 12/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 NEVIN AVE
RICHMOND CA
94801-3143
US

IV. Provider business mailing address

501 VINTAGE SPRINGS CT
FAIRFIELD CA
94534-6711
US

V. Phone/Fax

Practice location:
  • Phone: 510-307-3057
  • Fax:
Mailing address:
  • Phone: 707-319-5972
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227800000X
TaxonomyCertified Respiratory Therapist
License Number14472
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: