Provider Demographics
NPI:1881636413
Name:AYROSO, CARMEN V (MD)
Entity Type:Individual
Prefix:
First Name:CARMEN
Middle Name:V
Last Name:AYROSO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 OCEANGATE #100
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90802-4317
Mailing Address - Country:US
Mailing Address - Phone:562-499-6191
Mailing Address - Fax:562-499-6171
Practice Address - Street 1:11748 MAGNOLIA AVE #D
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92503-4955
Practice Address - Country:US
Practice Address - Phone:951-358-0141
Practice Address - Fax:951-358-0156
Is Sole Proprietor?:No
Enumeration Date:2006-06-11
Last Update Date:2008-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA31337207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A313370OtherMEDI CAL
CA00A31370Medicaid
CA00A313370OtherMEDI CAL
CA00A313371Medicare PIN
CA00A31370Medicaid
A84199Medicare UPIN
CA00A313372Medicare PIN
CA00A313375Medicare PIN
CA00A313374Medicare PIN
CA00A313370Medicare PIN