Provider Demographics
NPI:1649033184
Name:REBOLLAR, CARLOS
Entity type:Individual
Prefix:
First Name:CARLOS
Middle Name:
Last Name:REBOLLAR
Suffix:
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 1:1634 CHESTNUT AVE
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92008-2613
Mailing Address - Country:US
Mailing Address - Phone:619-200-4894
Mailing Address - Fax:
Practice Address - Street 1:2888 LOKER AVE E STE 105
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92010-6683
Practice Address - Country:US
Practice Address - Phone:619-739-4569
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-06
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician