Provider Demographics
NPI:1437124849
Name:CARBONE, GEORGE P (MD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:P
Last Name:CARBONE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2876 SYCAMORE DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93065-1550
Mailing Address - Country:US
Mailing Address - Phone:805-527-6424
Mailing Address - Fax:805-522-0115
Practice Address - Street 1:2876 SYCAMORE DR
Practice Address - Street 2:SUITE 101
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93065-1550
Practice Address - Country:US
Practice Address - Phone:805-527-6424
Practice Address - Fax:805-522-0115
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG47661207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G476610Medicaid
CAG47661Medicare ID - Type Unspecified
CAA50767Medicare UPIN