Provider Demographics
NPI:1700946209
Name:CARBUTO, MICHAEL NICHOLAS (DO)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:NICHOLAS
Last Name:CARBUTO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1250 N BELLFLOWER BLVD
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90840-0201
Mailing Address - Country:US
Mailing Address - Phone:562-985-4771
Mailing Address - Fax:562-985-8404
Practice Address - Street 1:1250 BELLFLOWER BLVD
Practice Address - Street 2:SHS
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90840-0201
Practice Address - Country:US
Practice Address - Phone:562-985-4771
Practice Address - Fax:562-985-8404
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A5571207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine