Basic Information
| Provider Information | |||||||||
| NPI: | 1184263295 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CARECONNECTMD INDIANA P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3090 BRISTOL ST STE 200 | ||||||||
| Address2: | |||||||||
| City: | COSTA MESA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926263061 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8887899585 | ||||||||
| FaxNumber: | 5628034500 | ||||||||
| Practice Location | |||||||||
| Address1: | 9465 COUNSELORS ROW STE 200 | ||||||||
| Address2: | |||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462403817 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8887899585 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/06/2020 | ||||||||
| LastUpdateDate: | 08/19/2022 | ||||||||
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| AuthorizedOfficialLastName: | COLLADO | ||||||||
| AuthorizedOfficialFirstName: | ORLANDO | ||||||||
| AuthorizedOfficialMiddleName: | ACOSTA | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 8887899585 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 08/19/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM1300X | Y | Ambulatory Health Care Facilities | Clinic/Center | Multi-Specialty |
No ID Information.