Provider Demographics
NPI:1043323488
Name:AMAZONA, CARLO (MD)
Entity Type:Individual
Prefix:
First Name:CARLO
Middle Name:
Last Name:AMAZONA
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:PO BOX 1559
Mailing Address - Street 2:1430 TRUXTON AVENUE STE 400
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93302-1559
Mailing Address - Country:US
Mailing Address - Phone:661-635-3050
Mailing Address - Fax:661-869-1503
Practice Address - Street 1:217 KERN AVENUE
Practice Address - Street 2:
Practice Address - City:MCFARLAND
Practice Address - State:CA
Practice Address - Zip Code:93250-1360
Practice Address - Country:US
Practice Address - Phone:661-792-3038
Practice Address - Fax:661-792-6270
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA43291208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A432910Medicare ID - Type Unspecified
B43722Medicare UPIN