Provider Demographics
NPI:1225328198
Name:CHANG, CARLOS (MEDICAL CERTIFIED)
Entity Type:Individual
Prefix:MR
First Name:CARLOS
Middle Name:
Last Name:CHANG
Suffix:
Gender:M
Credentials:MEDICAL CERTIFIED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1524 CIRCLE RANCH WAY UNIT 60
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92154-2214
Mailing Address - Country:US
Mailing Address - Phone:760-917-3487
Mailing Address - Fax:
Practice Address - Street 1:1524 CIRCLE RANCH WAY UNIT 60
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92057-5535
Practice Address - Country:US
Practice Address - Phone:760-917-3487
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-13
Last Update Date:2014-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC100915171R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171R00000XOther Service ProvidersInterpreter
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA100915OtherNATIONAL BOARD CERTIFED SPANISH INTERPRETER