Provider Demographics
NPI:1568648780
Name:CITRUS OBSTETRICS &GYNECOLOGY MEDICAL ASSOCIATES INC
Entity Type:Organization
Organization Name:CITRUS OBSTETRICS &GYNECOLOGY MEDICAL ASSOCIATES INC
Other - Org Name:CARLOS BEHARIE MD
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:S
Authorized Official - Last Name:BEHARIE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-337-8000
Mailing Address - Street 1:1433 W MERCED AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91790-3402
Mailing Address - Country:US
Mailing Address - Phone:626-337-8000
Mailing Address - Fax:626-337-1145
Practice Address - Street 1:1433 W MERCED AVE STE 103
Practice Address - Street 2:
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91790-3402
Practice Address - Country:US
Practice Address - Phone:626-337-8000
Practice Address - Fax:626-337-1145
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-17
Last Update Date:2014-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG46446174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G464460Medicaid
CAG46446Medicare PIN
CAF84261Medicare UPIN