Healthcare Provider Details

I. General information

NPI: 1376012567
Provider Name (Legal Business Name): CARL EVAN MASCARINAS BIRONDO NP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2018
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2121 WILSHIRE BLVD STE 303
SANTA MONICA CA
90403-5743
US

IV. Provider business mailing address

4441 ELIZABETH ST
CUDAHY CA
90201-5725
US

V. Phone/Fax

Practice location:
  • Phone: 888-777-1945
  • Fax: 805-413-9099
Mailing address:
  • Phone: 213-399-7948
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95010351
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: