Provider Demographics
NPI:1083771158
Name:LARINO, CARMELA (OD)
Entity Type:Individual
Prefix:
First Name:CARMELA
Middle Name:
Last Name:LARINO
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18800 AMAR RD
Mailing Address - Street 2:STE A5
Mailing Address - City:WALNUT
Mailing Address - State:CA
Mailing Address - Zip Code:91789-7100
Mailing Address - Country:US
Mailing Address - Phone:626-965-3878
Mailing Address - Fax:626-965-5662
Practice Address - Street 1:18800 AMAR RD
Practice Address - Street 2:STE A5
Practice Address - City:WALNUT
Practice Address - State:CA
Practice Address - Zip Code:91789-7100
Practice Address - Country:US
Practice Address - Phone:626-965-3878
Practice Address - Fax:626-965-5662
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2020-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10504152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0105040Medicaid
CAOP10504Medicare ID - Type Unspecified
CAU63032Medicare UPIN