MEDICARE: CARLOS M. LOREDO, PH.D., P.C.

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	103TC0700X	Clinical Psychologist	21637	TX

General Provider Information

NPI Number	:	1841336682
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARLOS M. LOREDO, PH.D., P.C.

Provider Business Mailing Address
First Line	:	2111 MONTCLAIRE ST
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78704-3909
Country	:	US
Telephone Number	:	512-443-0190
Fax Number	:

Provider Business Practice Location Address
First Line	:	2111 MONTCLAIRE ST
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78704-3909
Country	:	US
Telephone Number	:	512-443-0190
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. CARLOS M. LOREDO
Credential	:	PH.D.
Telephone Number	:	512-443-0190

Provider Enumeration Date	:	01/29/2007
Last Update Date	:	08/22/2020

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