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NPI Code Detail

MEDICARE: DR. CARLOS J CARRERA M.D.

MEDICARE: DR. CARLOS J CARRERA M.D.
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
12084P0800XPsychiatry Physician55594MA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1679579213
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. CARLOS J CARRERA M.D.
Provider Business Mailing Address
First Line : 650 E INDIAN SCHOOL RD
Second Line :
City : PHOENIX
State : AZ
Zip : 85012-1839
Country : US
Telephone Number : 602-277-5551
Fax Number : 602-200-6026
Provider Business Practice Location Address
First Line : 650 E INDIAN SCHOOL RD
Second Line :
City : PHOENIX
State : AZ
Zip : 85012-1839
Country : US
Telephone Number : 602-277-5551
Fax Number : 602-200-6026
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/27/2005
Last Update Date : 05/09/2013

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