Provider Demographics
NPI:1184035032
Name:CARLOS BEHARIE M.D. MEDICAL GROUP, INC.
Entity Type:Organization
Organization Name:CARLOS BEHARIE M.D. MEDICAL GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BOJORQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-652-0790
Mailing Address - Street 1:4160 MAINE AVE STE B1B2B3
Mailing Address - Street 2:
Mailing Address - City:BALDWIN PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91706-3304
Mailing Address - Country:US
Mailing Address - Phone:626-653-0800
Mailing Address - Fax:626-244-0485
Practice Address - Street 1:4160 N. MAINE AVE, SUITE B1, B2, B3
Practice Address - Street 2:
Practice Address - City:BALDWIN PARK
Practice Address - State:CA
Practice Address - Zip Code:91706-3304
Practice Address - Country:US
Practice Address - Phone:626-653-0800
Practice Address - Fax:626-244-0485
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-14
Last Update Date:2014-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA207QA0505X, 207VG0400X, 2080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Multi-Specialty
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Multi-Specialty
No2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG46446AMedicare PIN
CAF84261Medicare UPIN