Basic Information
| Provider Information | |||||||||
| NPI: | 1487272647 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHEN | ||||||||
| FirstName: | CARLITOS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10 W BAY STATE ST UNIT 684 | ||||||||
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| City: | ALHAMBRA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 918022828 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 950 S ARROYO PKWY STE 310 | ||||||||
| Address2: | |||||||||
| City: | PASADENA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 911053930 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6264494859 | ||||||||
| FaxNumber: | 6264030311 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/13/2020 | ||||||||
| LastUpdateDate: | 07/10/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 09/01/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208200000X | 58795 | CA | N | Allopathic & Osteopathic Physicians | Plastic Surgery | 363A00000X | 58795 | CA | Y | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.