Provider Demographics
NPI:1801094131
Name:BEHARIE, CARLOS S (MD)
Entity type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:S
Last Name:BEHARIE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1433 W. MERCED AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91790-3402
Mailing Address - Country:US
Mailing Address - Phone:626-652-0790
Mailing Address - Fax:626-652-0799
Practice Address - Street 1:1433 W MERCED AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91790-3402
Practice Address - Country:US
Practice Address - Phone:626-337-8000
Practice Address - Fax:626-337-1145
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-09
Last Update Date:2014-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG46446207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G464460Medicaid
CA1801094131OtherINDIVIDUAL NPI
CA00G46446AMedicaid
CA00G464460Medicaid
CAG46446AMedicare PIN