Provider Demographics
NPI:1265714349
Name:CARLOS M FIGUEROA, MD, A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:CARLOS M FIGUEROA, MD, A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:M
Authorized Official - Last Name:FIGUEROA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-795-5156
Mailing Address - Street 1:1118 E GREEN ST
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91106-2500
Mailing Address - Country:US
Mailing Address - Phone:626-795-5156
Mailing Address - Fax:626-795-5013
Practice Address - Street 1:1118 E GREEN ST
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91106-2500
Practice Address - Country:US
Practice Address - Phone:626-795-5156
Practice Address - Fax:626-795-5013
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-14
Last Update Date:2011-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG446732084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00WG44673AOtherMEDICARE
CA1760499511OtherINDIVIDUAL NPI
CA00G446730Medicaid
CA00WG44673AOtherMEDICARE