Basic Information
| Provider Information | |||||||||
| NPI: | 1528055795 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CARLOS BEHARIE MD MEDICAL GROUP INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10050 GARVEY AVE | ||||||||
| Address2: | #111 | ||||||||
| City: | EL MONTE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917332088 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6266520790 | ||||||||
| FaxNumber: | 6266520799 | ||||||||
| Practice Location | |||||||||
| Address1: | 2542 E FLORENCE AVE | ||||||||
| Address2: | #B | ||||||||
| City: | WALNUT PARK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902554780 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3235848700 | ||||||||
| FaxNumber: | 3235845472 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/04/2005 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | BEHARIE | ||||||||
| AuthorizedOfficialFirstName: | CARLOS | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 3235848700 | ||||||||
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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 | X | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 208000000X | A31300 | CA | X | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | GR0095570 | 01 | MEDI-CAL | OTHER |