Provider Demographics
NPI:1720759871
Name:CARPIO-BRACHO & GUTIERREZ, A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:CARPIO-BRACHO & GUTIERREZ, A MEDICAL CORPORATION
Other - Org Name:PRIDE SPORTS MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GABRIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:CARPIO-BRACHO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:559-944-9298
Mailing Address - Street 1:3636 N 1ST ST STE 160
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93726-6869
Mailing Address - Country:US
Mailing Address - Phone:559-944-9298
Mailing Address - Fax:
Practice Address - Street 1:3636 N 1ST ST STE 160
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93726-6869
Practice Address - Country:US
Practice Address - Phone:559-944-9298
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-27
Last Update Date:2022-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports MedicineGroup - Single Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty