Provider Demographics
NPI:1033892930
Name:CARLOS, BIEN LEGASPI SR
Entity Type:Individual
Prefix:MR
First Name:BIEN
Middle Name:LEGASPI
Last Name:CARLOS
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12818 BLOOMFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CA
Mailing Address - Zip Code:90650-3247
Mailing Address - Country:US
Mailing Address - Phone:562-290-9984
Mailing Address - Fax:
Practice Address - Street 1:12818 BLOOMFIELD AVE
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CA
Practice Address - Zip Code:90650-3247
Practice Address - Country:US
Practice Address - Phone:562-290-9984
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-08
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAD4148764172A00000X
CAP027738174200000X, 374700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374700000XNursing Service Related ProvidersTechnician
No172A00000XOther Service ProvidersDriver
No174200000XOther Service ProvidersMeals