Basic Information
| Provider Information | |||||||||
| NPI: | 1528054418 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CARLOS BEHARIE MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1433 W MERCED AVE | ||||||||
| Address2: | #103 | ||||||||
| City: | WEST COVINA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917903402 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6263378000 | ||||||||
| FaxNumber: | 6263371145 | ||||||||
| Practice Location | |||||||||
| Address1: | 1433 W MERCED AVE | ||||||||
| Address2: | #103 | ||||||||
| City: | WEST COVINA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917903402 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6263378000 | ||||||||
| FaxNumber: | 6263371145 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/26/2005 | ||||||||
| LastUpdateDate: | 11/19/2009 | ||||||||
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| AuthorizedOfficialLastName: | BEHARIE | ||||||||
| AuthorizedOfficialFirstName: | CARLOS | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRACTITIONER | ||||||||
| AuthorizedOfficialTelephone: | 6263378000 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | G46446 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 00G464460 | 01 | MEDI-CAL | OTHER |