Healthcare Provider Details

I. General information

NPI: 1346749546
Provider Name (Legal Business Name): CARLO RADA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2018
Last Update Date: 05/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 GOV CARLOS G CAMACHO RD
TAMUNING GU
96913
US

IV. Provider business mailing address

215 SUMMERVILLE DR APT 1715
TAMUNING GU
96913-4386
US

V. Phone/Fax

Practice location:
  • Phone: 671-647-2179
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: