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NPI Code Detail

MEDICARE: KEENAN SINCLAIR CARRIERO DPM

MEDICARE: KEENAN SINCLAIR CARRIERO DPM
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
1213ES0103XFoot & Ankle Surgery PodiatristE4509CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
103-0431018OTHERCATRICARE
2ZZZ04918ZOTHERCABLUE SHIELD

General Provider Information

NPI Number : 1366534075
Entity Type Code : Individual
Provider Name (Legal Business Name) : KEENAN SINCLAIR CARRIERO DPM
Provider Business Mailing Address
First Line : 310 SANTA FE DR STE 112
Second Line :
City : ENCINITAS
State : CA
Zip : 92024-5123
Country : US
Telephone Number : 760-642-7009
Fax Number : 760-230-1453
Provider Business Practice Location Address
First Line : 310 SANTA FE DR STE 112
Second Line :
City : ENCINITAS
State : CA
Zip : 92024-5123
Country : US
Telephone Number : 760-642-7009
Fax Number : 760-230-1453
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/29/2006
Last Update Date : 03/17/2018

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