Provider Demographics
NPI:1649293705
Name:CARABELLO, VICTOR G (MD)
Entity type:Individual
Prefix:
First Name:VICTOR
Middle Name:G
Last Name:CARABELLO
Suffix:
Gender:M
Credentials:MD
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Other - Last Name:
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Mailing Address - Street 1:1700 E CESAR E CHAVEZ AVE
Mailing Address - Street 2:STE L-200
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90033-2424
Mailing Address - Country:US
Mailing Address - Phone:323-526-2880
Mailing Address - Fax:323-526-2885
Practice Address - Street 1:1701 E CESAR E CHAVEZ AVE
Practice Address - Street 2:SUITE #100
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033-2464
Practice Address - Country:US
Practice Address - Phone:323-987-1362
Practice Address - Fax:323-987-1365
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2014-09-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG74827207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G748270Medicaid
CA00G748270Medicaid
CAG66103Medicare UPIN