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General NPI Number Information
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NPI Number | 1093697930
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Entity Type | Individual
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Provider Name | MIKE ANTHONY CARCANO
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Gender | Male
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Dates
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Enumeration Date | 07/22/2025
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Last Update Date | 07/23/2025
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Provider Practice Location Address
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Address Line | 9140 VAN NUYS BLVD UNIT 202-207
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City | PANORAMA CITY
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State | CA
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Zip | 91402-6727
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Country | US
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Telephone | 818-895-2206
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Fax |
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Provider Business Mailing Address
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Address Line | 13775 OSBORNE STREET
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City | ARLETA
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State | CA
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Zip | 91331
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Country | US
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Telephone | 818-689-1297
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 25169
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License Number State | CA
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