Provider Demographics
NPI:1588601595
Name:CARRASCO, ARTHUR JR (MD)
Entity Type:Individual
Prefix:
First Name:ARTHUR
Middle Name:
Last Name:CARRASCO
Suffix:JR
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 1:8255 FIRESTONE BLVD
Mailing Address - Street 2:SUITE 501
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90241-4800
Mailing Address - Country:US
Mailing Address - Phone:562-319-2085
Mailing Address - Fax:562-923-7112
Practice Address - Street 1:8255 FIRESTONE BLVD
Practice Address - Street 2:SUITE 501
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90241-4800
Practice Address - Country:US
Practice Address - Phone:562-319-2085
Practice Address - Fax:562-923-7112
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-31
Last Update Date:2015-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG68513207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G685130Medicaid
CA110162350OtherRAILROAD
051139OtherHEALTHNET ID #
00G685130OtherBLUE SHIELD ID #
CAWG68513FMedicare PIN
CAWG67619EMedicare PIN
CA110162350OtherRAILROAD