=====================================================
General NPI Number Information
=====================================================
NPI Number | 1689828105
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CARMELITA UY MD INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/11/2008
-----------------------------------------------------
Last Update Date | 04/18/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2340 EAST 8TH STREET SUITE-E
-----------------------------------------------------
City | NATIONAL CITY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91950-2870
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 619-216-8500
-----------------------------------------------------
Fax | 619-216-8511
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2340 EAST 8TH STREET SUITE-E
-----------------------------------------------------
City | NATIONAL CITY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91950-2870
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 619-216-8500
-----------------------------------------------------
Fax | 619-216-8511
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MRS. CARMELITA LUNA UY
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 619-216-8500
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | C50548
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------