Provider Demographics
NPI:1457594939
Name:ERICK F. CARCAMO A PROFESSIONAL MEDICAL CORPORATION
Entity Type:Organization
Organization Name:ERICK F. CARCAMO A PROFESSIONAL MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCAATOR
Authorized Official - Prefix:
Authorized Official - First Name:ERICK
Authorized Official - Middle Name:F
Authorized Official - Last Name:CARCAMO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-337-1360
Mailing Address - Street 1:14307 RAMONA BLVD
Mailing Address - Street 2:
Mailing Address - City:BALDWIN PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91706-3242
Mailing Address - Country:US
Mailing Address - Phone:626-337-1360
Mailing Address - Fax:626-338-3861
Practice Address - Street 1:14650 PACIFIC AVE
Practice Address - Street 2:
Practice Address - City:BALDWIN PARK
Practice Address - State:CA
Practice Address - Zip Code:91706-5333
Practice Address - Country:US
Practice Address - Phone:626-337-1360
Practice Address - Fax:626-338-3861
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ERICK F. CARCAMO MD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-04-13
Last Update Date:2019-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA53329208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA05D0906608OtherCLIA
CA00A533290Medicaid
CA0750127Medicare PIN
CAF92227Medicare UPIN
CAA53329Medicare Oscar/Certification