1043323488 NPI number — CARLO AMAZONA MD

Table of content: CARLO AMAZONA MD (NPI 1043323488)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043323488 NPI number — CARLO AMAZONA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AMAZONA
Provider First Name:
CARLO
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1043323488
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1559
Provider Second Line Business Mailing Address:
1430 TRUXTON AVENUE STE 400
Provider Business Mailing Address City Name:
BAKERSFIELD
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93302-1559
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
661-635-3050
Provider Business Mailing Address Fax Number:
661-869-1503

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
217 KERN AVENUE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MCFARLAND
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93250-1360
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-792-3038
Provider Business Practice Location Address Fax Number:
661-792-6270
Provider Enumeration Date:
08/17/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208D00000X , with the licence number:  A43291 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)