NPIMap

Organization Active NPI

Mario Carcamo MD Inc

  • Specialist
  • Riverside, CA
National Provider Identifier
1821271412
Registry record updated Dec 6, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
A35551 Issued in CA
Legal business name
MARIO CARCAMO MD INC
Practice address
4440 Brockton Ave Ste 420
Riverside, CA 92501-4026
Phone
(951) 684-8020
Fax
(951) 684-8090
NPI assigned
Dec 6, 2007
Last updated
Dec 6, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 6, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mario P Carcamo, M.D.NPI 1518916725
Title
Ceo
Phone
(951) 684-8020

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193400000X SINGLE SPECIALTY GROUP 174400000X A35551 CA Primary

Addresses

Primary practice location

4440 Brockton Ave Ste 420
Riverside, CA 92501-4026

Mailing address

4440 Brockton Ave Ste 420
Riverside, CA 92501-4026
Phone (951) 684-8020

Other identifiers 1

IdentifierTypeStateIssuer
GR0102440MedicaidCA

National Provider Directory

National Provider Directory

Locations

3975 Jackson St
Ste 108
Riverside, CA 92503
Phone (951) 687-7851

4440 Brockton Ave
Ste 420
Riverside, CA 92501
Phone (951) 684-8020

4444 Magnolia Ave
Ste 300
Riverside, CA 92501
Phone (951) 684-8020

Practitioners & affiliated clinicians

Practitioners 12

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1196899200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1196899200000",
    "number": "1821271412",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4440 BROCKTON AVE STE 420",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925014026",
            "telephone_number": "951-684-8020",
            "fax_number": "951-684-8090"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4440 BROCKTON AVE STE 420",
            "city": "RIVERSIDE",
            "state": "CA",
            "postal_code": "925014026",
            "telephone_number": "951-684-8020",
            "fax_number": "951-684-8090"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARIO CARCAMO MD INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-06",
        "last_updated": "2007-12-06",
        "status": "A",
        "authorized_official_last_name": "CARCAMO",
        "authorized_official_first_name": "MARIO",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "951-684-8020",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "CA",
            "license": "A35551",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0102440",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Riverside, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.