MEDICARE: CARRASCO PODIATRY CORPORATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213E00000X	Podiatrist	E3608	CA

General Provider Information

NPI Number	:	1043339260
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARRASCO PODIATRY CORPORATION

Provider Business Mailing Address
First Line	:	PO BOX 4347
Second Line	:
City	:	RANCHO CUCAMONGA
State	:	CA
Zip	:	91729-4347
Country	:	US
Telephone Number	:	951-212-6661
Fax Number	:	909-987-3292

Provider Business Practice Location Address
First Line	:	7196 SUNNYSIDE PL
Second Line	:
City	:	RANCHO CUCAMONGA
State	:	CA
Zip	:	91739-5995
Country	:	US
Telephone Number	:	951-212-6661
Fax Number	:	909-987-3292

Authorized Official
Title or Position	:	DOCTOR OF PODIATRIC MEDICINE
Name	:	DR. PETE CARRASCO JR.
Credential	:	D.P.M.
Telephone Number	:	951-212-6661

Provider Enumeration Date	:	03/28/2007
Last Update Date	:	11/11/2012

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Directions to “CARRASCO PODIATRY CORPORATION ” Practice Location

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