=====================================================
General NPI Number Information
=====================================================
NPI Number | 1013288117
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GUILHERME R CARVALHO M.D. INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/20/2012
-----------------------------------------------------
Last Update Date | 01/20/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 118 N SANTA FE ST STE A
-----------------------------------------------------
City | HEMET
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92543-4441
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 951-652-6891
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 118 N SANTA FE ST STE A
-----------------------------------------------------
City | HEMET
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92543-4441
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | CHITRA CARVALHO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 951-652-6891
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | A33335
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------