Provider Demographics
NPI:1578792164
Name:CARLOS, VIRGINIA J
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:J
Last Name:CARLOS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1441 CONSTITUTION BLVD
Mailing Address - Street 2:BLDG 200 FL. 1 SUITE 100
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93906-3100
Mailing Address - Country:US
Mailing Address - Phone:831-755-4124
Mailing Address - Fax:
Practice Address - Street 1:1615 BUNKER HILL WAY
Practice Address - Street 2:SUITE #100
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93906-6010
Practice Address - Country:US
Practice Address - Phone:831-796-1304
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-06
Last Update Date:2009-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA544943163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1457303356OtherCLINIC NPI
CAFHC70126FMedicaid
CAHAP70126FMedicaid