Provider Demographics
NPI:1144231028
Name:CARLOS T. DE CARVALHO, M.D. INC
Entity Type:Organization
Organization Name:CARLOS T. DE CARVALHO, M.D. INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:T
Authorized Official - Last Name:DE CARVALHO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:619-422-6158
Mailing Address - Street 1:629 THIRD AVE STE A
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91910-5786
Mailing Address - Country:US
Mailing Address - Phone:619-422-6158
Mailing Address - Fax:619-422-2019
Practice Address - Street 1:629 THIRD AVE STE A
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-5786
Practice Address - Country:US
Practice Address - Phone:619-422-6158
Practice Address - Fax:619-422-2019
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2021-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA38504207R00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW11168Medicare PIN