Provider Demographics
NPI:1720366644
Name:JORGE CARREON, M.D., INC.
Entity Type:Organization
Organization Name:JORGE CARREON, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D./ OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:F
Authorized Official - Last Name:CARREON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:323-567-9661
Mailing Address - Street 1:PO BOX 27206
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90027-0206
Mailing Address - Country:US
Mailing Address - Phone:213-385-0675
Mailing Address - Fax:213-365-6429
Practice Address - Street 1:4500 TWEEDY BLVD
Practice Address - Street 2:
Practice Address - City:SOUTH GATE
Practice Address - State:CA
Practice Address - Zip Code:90280-6334
Practice Address - Country:US
Practice Address - Phone:323-567-9661
Practice Address - Fax:323-567-9663
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-26
Last Update Date:2011-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA32576207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty