Provider Demographics
NPI:1033149356
Name:CARBAYO, ANTONIO (MD)
Entity Type:Individual
Prefix:
First Name:ANTONIO
Middle Name:
Last Name:CARBAYO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1911 N BROADWAY
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92706-2609
Mailing Address - Country:US
Mailing Address - Phone:714-667-6900
Mailing Address - Fax:714-667-6116
Practice Address - Street 1:1911 N BROADWAY
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92706-2609
Practice Address - Country:US
Practice Address - Phone:714-667-6900
Practice Address - Fax:714-667-6116
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2018-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG79962207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G799620Medicaid
CAG79962Medicare ID - Type Unspecified
CAH16524Medicare UPIN