Healthcare Provider Details

I. General information

NPI: 1336166396
Provider Name (Legal Business Name): CARLOS URIEL CORVERA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4150 CLEMENT ST
SAN FRANCISCO CA
94121-1545
US

IV. Provider business mailing address

4150 CLEMENT ST
SAN FRANCISCO CA
94121-1545
US

V. Phone/Fax

Practice location:
  • Phone: 415-750-6922
  • Fax: 415-750-2181
Mailing address:
  • Phone: 415-750-6922
  • Fax: 415-750-2181

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code286500000X
TaxonomyMilitary Hospital
License NumberG081669
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: