Provider Demographics
NPI:1376712273
Name:CLAUDIO M. CARVALHO, D.O, A PROFESSIONAL MEDICAL CORPORATION
Entity Type:Organization
Organization Name:CLAUDIO M. CARVALHO, D.O, A PROFESSIONAL MEDICAL CORPORATION
Other - Org Name:FUNCTIONAL ORTHOPEDIC REHABILITATION MEDICINE ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SONMI
Authorized Official - Middle Name:
Authorized Official - Last Name:CARVALHO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-999-0777
Mailing Address - Street 1:230 EAST 17TH STREET
Mailing Address - Street 2:SUITE 202
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92627-3824
Mailing Address - Country:US
Mailing Address - Phone:949-999-0777
Mailing Address - Fax:949-999-0784
Practice Address - Street 1:230 E 17TH ST
Practice Address - Street 2:SUITE 202
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92627-3824
Practice Address - Country:US
Practice Address - Phone:949-999-0777
Practice Address - Fax:949-999-0784
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-25
Last Update Date:2010-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A8191208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW19580Medicare PIN
CA6365290001Medicare NSC