Provider Demographics
NPI:1356047500
Name:PRINCE, CARLOS JR
Entity type:Individual
Prefix:MR
First Name:CARLOS
Middle Name:
Last Name:PRINCE
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 PLAZA DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ROCKLIN
Mailing Address - State:CA
Mailing Address - Zip Code:95765
Mailing Address - Country:US
Mailing Address - Phone:888-922-2843
Mailing Address - Fax:855-568-2494
Practice Address - Street 1:209 PLAZA DR
Practice Address - Street 2:SUITE 100
Practice Address - City:ROCKLIN
Practice Address - State:CA
Practice Address - Zip Code:95765
Practice Address - Country:US
Practice Address - Phone:888-922-2843
Practice Address - Fax:855-568-2494
Is Sole Proprietor?:No
Enumeration Date:2023-01-31
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician