Provider Demographics
NPI:1073360244
Name:LERO, CARL ORIEL RAZ (NP)
Entity type:Individual
Prefix:
First Name:CARL ORIEL
Middle Name:RAZ
Last Name:LERO
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9069 HIGHTAIL DR
Mailing Address - Street 2:
Mailing Address - City:SANTEE
Mailing Address - State:CA
Mailing Address - Zip Code:92071-2055
Mailing Address - Country:US
Mailing Address - Phone:619-530-9026
Mailing Address - Fax:
Practice Address - Street 1:1419 E 8TH ST
Practice Address - Street 2:
Practice Address - City:NATIONAL CITY
Practice Address - State:CA
Practice Address - Zip Code:91950-2602
Practice Address - Country:US
Practice Address - Phone:619-718-1743
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-04
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95028468363LA2100X
CA848788163WX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163WX0800XNursing Service ProvidersRegistered NurseOrthopedic