Basic Information
| Provider Information | |||||||||
| NPI: | 1164617601 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CARLITO | ||||||||
| FirstName: | LEONARDO | ||||||||
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| Credential: | MPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 590 N SIERRA WAY | ||||||||
| Address2: | |||||||||
| City: | SAN BERNARDINO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 924104817 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9098888152 | ||||||||
| FaxNumber: | 9098826110 | ||||||||
| Practice Location | |||||||||
| Address1: | 590 N SIERRA WAY | ||||||||
| Address2: | |||||||||
| City: | SAN BERNARDINO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 924104817 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9098888152 | ||||||||
| FaxNumber: | 9098826110 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/07/2007 | ||||||||
| LastUpdateDate: | 01/02/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208100000X | 1139400 | TX | Y | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |
No ID Information.