Basic Information
| Provider Information | |||||||||
| NPI: | 1528271962 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CARO | ||||||||
| FirstName: | MANUEL | ||||||||
| MiddleName: | JAVIER | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | RAS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2318 WORKMAN ST | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900312370 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 672 S LA FAYETTE PARK PL | ||||||||
| Address2: | #6 | ||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900573251 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2133813626 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/08/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.