Provider Demographics
NPI:1164521274
Name:CARLOS M DAYRIT JR MD INC
Entity Type:Organization
Organization Name:CARLOS M DAYRIT JR MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:M
Authorized Official - Last Name:DAYRIT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:562-547-2006
Mailing Address - Street 1:18112 HARVEST AVE
Mailing Address - Street 2:
Mailing Address - City:CERRITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90703-5551
Mailing Address - Country:US
Mailing Address - Phone:562-547-2006
Mailing Address - Fax:
Practice Address - Street 1:18112 HARVEST AVE
Practice Address - Street 2:
Practice Address - City:CERRITOS
Practice Address - State:CA
Practice Address - Zip Code:90703-5551
Practice Address - Country:US
Practice Address - Phone:562-547-2006
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2007-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA34641207P00000X, 207Q00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA84671OtherLICENSE NUMBER
CA00A346410Medicaid
CAA34641Medicare PIN
CA00A346410Medicaid