Provider Demographics
NPI:1952362964
Name:CARLOS, VICTOR RAMON (DPT)
Entity Type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:RAMON
Last Name:CARLOS
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:22311 BROOKHURST ST
Mailing Address - Street 2:UNIT 8
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92646-8450
Mailing Address - Country:US
Mailing Address - Phone:714-965-2222
Mailing Address - Fax:
Practice Address - Street 1:24012 CALLE DE LA PLATA
Practice Address - Street 2:200
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-3621
Practice Address - Country:US
Practice Address - Phone:949-583-9251
Practice Address - Fax:949-583-9246
Is Sole Proprietor?:No
Enumeration Date:2006-03-29
Last Update Date:2018-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT26966225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q45316Medicare UPIN
WPT26966AMedicare ID - Type Unspecified