Provider Demographics
NPI:1942285507
Name:ALCID, CARLA MARIA PEREDO (MD)
Entity Type:Individual
Prefix:
First Name:CARLA MARIA
Middle Name:PEREDO
Last Name:ALCID
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 1:1201 W LA VETA AVE
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-4203
Mailing Address - Country:US
Mailing Address - Phone:502-541-2637
Mailing Address - Fax:949-748-6664
Practice Address - Street 1:1201 W LA VETA AVE
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-4203
Practice Address - Country:US
Practice Address - Phone:502-541-2637
Practice Address - Fax:949-748-6664
Is Sole Proprietor?:No
Enumeration Date:2005-12-07
Last Update Date:2013-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY33113208000000X, 2080P0204X
LA2024092080P0204X, 208000000X
CAA52709207PP0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PP0204XAllopathic & Osteopathic PhysiciansEmergency MedicinePediatric Emergency Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080P0204XAllopathic & Osteopathic PhysiciansPediatricsPediatric Emergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200179840Medicaid
KY64333115Medicaid
F70483Medicare UPIN
IN200179840Medicaid