Provider Demographics
NPI:1376702530
Name:CARMELITA L UY MD,INC
Entity Type:Organization
Organization Name:CARMELITA L UY MD,INC
Other - Org Name:LABODA PEDIATRIC CENTER, INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CARMELITA
Authorized Official - Middle Name:LUNA
Authorized Official - Last Name:UY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:619-216-8500
Mailing Address - Street 1:1040 TIERRA DEL REY
Mailing Address - Street 2:SUITE 107
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91910-7865
Mailing Address - Country:US
Mailing Address - Phone:619-216-8500
Mailing Address - Fax:619-216-8511
Practice Address - Street 1:2036 DAIRY MART RD
Practice Address - Street 2:SUITE 129
Practice Address - City:SAN YSIDRO
Practice Address - State:CA
Practice Address - Zip Code:92173-1883
Practice Address - Country:US
Practice Address - Phone:619-662-1088
Practice Address - Fax:619-662-1097
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-03
Last Update Date:2008-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC50548173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C505481Medicaid