Healthcare Provider Details

I. General information

NPI: 1932519733
Provider Name (Legal Business Name): CARLOS SILVA D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2014
Last Update Date: 12/08/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 E 4TH ST
SANTA ANA CA
92705-3910
US

IV. Provider business mailing address

PO BOX 23146
SANTA ANA CA
92711-3146
US

V. Phone/Fax

Practice location:
  • Phone: 714-967-4766
  • Fax: 714-967-4548
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number14429
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: