Provider Demographics
NPI:1194221432
Name:CARMONA, GEORGE THOMAS
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:THOMAS
Last Name:CARMONA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:748 CALDWELL PL
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARA
Mailing Address - State:CA
Mailing Address - Zip Code:95051-5700
Mailing Address - Country:US
Mailing Address - Phone:786-417-5120
Mailing Address - Fax:
Practice Address - Street 1:748 CALDWELL PL
Practice Address - Street 2:
Practice Address - City:SANTA CLARA
Practice Address - State:CA
Practice Address - Zip Code:95051-5700
Practice Address - Country:US
Practice Address - Phone:786-417-5120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-04
Last Update Date:2018-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician