Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | G33363 | CA |
N | 111NI0900X | Internist | G33363 | CA |
Y | 207RH0000X | Hematologist | G33363 | CA |
N | 207RH0003X | Hematology & Oncology | G33363 | CA |
N | 207RX0202X | Medical Oncology | G33363 | CA |
NPI | 1417050345 |
---|---|
Provider Name | Carlos Jose Carrera |
First Address | La Jolla, CA 92093-0698 |
Second Address | San Diego, CA 92103-8201 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/09/2006 |
Last Update Date | 09/07/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G333630 | (05) | CA |
F48644 | (02) |