Provider Demographics
NPI:1730127515
Name:CARLOS, BRIAN D (MD)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:D
Last Name:CARLOS
Suffix:
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:PO BOX 230757
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92023-0757
Mailing Address - Country:US
Mailing Address - Phone:760-944-7300
Mailing Address - Fax:760-633-3949
Practice Address - Street 1:320 SANTA FE DR
Practice Address - Street 2:SUITE 204
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-5138
Practice Address - Country:US
Practice Address - Phone:760-944-7300
Practice Address - Fax:760-633-3949
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD21044207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD856421300Medicaid
DC025550900Medicaid
CA00C522200Medicaid
VA5822351Medicaid
DCG65468Medicare UPIN
VA5822351Medicaid
DC060052607Medicare ID - Type UnspecifiedRAILROAD
DC025550900Medicaid