Provider Demographics
NPI:1831155472
Name:OVIEDO, CARLOS FRANCISCO (L AC)
Entity type:Individual
Prefix:
First Name:CARLOS
Middle Name:FRANCISCO
Last Name:OVIEDO
Suffix:
Gender:M
Credentials:L AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 DORCHESTER AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90032-2906
Mailing Address - Country:US
Mailing Address - Phone:323-222-8704
Mailing Address - Fax:
Practice Address - Street 1:716 S VICTORY BLVD
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91502-2425
Practice Address - Country:US
Practice Address - Phone:323-481-1991
Practice Address - Fax:818-843-3610
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 6929171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAC0069290OtherMEDI-CAL
CACO1061969OtherAMERICAN SPECIALTY HEALTH