Provider Demographics
NPI:1013089069
Name:CAREN, JEFFREY FREDRICK (MD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:FREDRICK
Last Name:CAREN
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 1:8635 W 3RD ST
Mailing Address - Street 2:890W
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-6101
Mailing Address - Country:US
Mailing Address - Phone:310-659-0714
Mailing Address - Fax:310-659-0664
Practice Address - Street 1:8635 W 3RD ST
Practice Address - Street 2:890W
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-6101
Practice Address - Country:US
Practice Address - Phone:310-659-0714
Practice Address - Fax:310-659-0664
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2016-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG22674174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA41665Medicare UPIN
CAW13231Medicare ID - Type UnspecifiedPROVIDER