Provider Demographics
NPI:1336186493
Name:CARLIN, CHRISTOPHER SCOTT (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:SCOTT
Last Name:CARLIN
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:PO BOX 894830
Mailing Address - Street 2:LOCK BOX 4830
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90189-4830
Mailing Address - Country:US
Mailing Address - Phone:909-335-8649
Mailing Address - Fax:909-335-8649
Practice Address - Street 1:1300 AVENIDA VISTA HERMOSA
Practice Address - Street 2:SUITE 240
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92673-6315
Practice Address - Country:US
Practice Address - Phone:949-489-4290
Practice Address - Fax:949-489-4293
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2013-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA80306207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP00342644OtherRAILROAD MEDICARE
CAAV670WMedicare PIN
CAWA80306AMedicare PIN
CAI54035Medicare UPIN
CAWA80306BMedicare PIN
CAP00342644OtherRAILROAD MEDICARE
CAWA80306FMedicare PIN
CAAV670ZMedicare PIN
CAWA80306DMedicare PIN
CAWA80306EMedicare PIN
CA00A803060Medicare PIN