Provider Demographics
NPI:1851474852
Name:DECARLO, CHRISTOPHER P (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:P
Last Name:DECARLO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1520 NUTMEG PL
Mailing Address - Street 2:SUITE 110
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-2501
Mailing Address - Country:US
Mailing Address - Phone:714-751-8110
Mailing Address - Fax:714-918-0322
Practice Address - Street 1:1520 NUTMEG PL
Practice Address - Street 2:SUITE 110
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-2501
Practice Address - Country:US
Practice Address - Phone:714-751-8110
Practice Address - Fax:714-918-0322
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2015-11-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAC515352081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWC51535BMedicare ID - Type Unspecified
CAG90369Medicare UPIN