Provider Demographics
NPI:1184728586
Name:CARRERA, JORGE A (MD)
Entity type:Individual
Prefix:
First Name:JORGE
Middle Name:A
Last Name:CARRERA
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 1:285 N. EL CAMINO REAL
Mailing Address - Street 2:STE #205
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024
Mailing Address - Country:US
Mailing Address - Phone:760-635-1777
Mailing Address - Fax:760-635-1779
Practice Address - Street 1:285 N. EL CAMINO REAL
Practice Address - Street 2:STE #205
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024
Practice Address - Country:US
Practice Address - Phone:760-635-1777
Practice Address - Fax:760-635-1779
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-07
Last Update Date:2009-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG58033207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G58033Medicaid
CAG58033Medicare ID - Type Unspecified
CAE50203Medicare UPIN