Provider Demographics
NPI:1639591407
Name:CARLO P. HONRADO, M.D., INC.
Entity Type:Organization
Organization Name:CARLO P. HONRADO, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CARLO
Authorized Official - Middle Name:P
Authorized Official - Last Name:HONRADO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-201-0717
Mailing Address - Street 1:2080 CENTURY PARK E
Mailing Address - Street 2:1700
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90067-2001
Mailing Address - Country:US
Mailing Address - Phone:310-201-0717
Mailing Address - Fax:310-201-9665
Practice Address - Street 1:2080 CENTURY PARK E
Practice Address - Street 2:1700
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90067-2001
Practice Address - Country:US
Practice Address - Phone:310-201-0717
Practice Address - Fax:310-201-9665
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-14
Last Update Date:2014-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA102560207YX0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYH85623Medicare UPIN