Provider Demographics
NPI:1568599876
Name:ORREGO, CARLOS (MD)
Entity Type:Individual
Prefix:
First Name:CARLOS
Middle Name:
Last Name:ORREGO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 37337
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85069-7337
Mailing Address - Country:US
Mailing Address - Phone:623-439-9494
Mailing Address - Fax:623-439-9495
Practice Address - Street 1:926 E MCDOWELL RD STE 203
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85006-2508
Practice Address - Country:US
Practice Address - Phone:623-439-9494
Practice Address - Fax:623-439-9495
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2020-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ51183207RA0001X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RA0001XAllopathic & Osteopathic PhysiciansInternal MedicineAdvanced Heart Failure and Transplant Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ071498Medicaid
LA1801682Medicaid
TXP00459995OtherRAILROAD MEDICARE
TX190437701Medicaid
TX8W8475OtherBLUE CROSS BLUE SHIELD
LA1801682Medicaid
TX190437701Medicaid
8K2553Medicare PIN