Provider Demographics
NPI:1104893072
Name:MAKABALI, CARLOS GARCIA (MD)
Entity type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:GARCIA
Last Name:MAKABALI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 E BEVERLY BLVD
Mailing Address - Street 2:SUITE 307
Mailing Address - City:MONTEBELLO
Mailing Address - State:CA
Mailing Address - Zip Code:90640-4300
Mailing Address - Country:US
Mailing Address - Phone:323-888-2548
Mailing Address - Fax:323-888-1741
Practice Address - Street 1:101 E BEVERLY BLVD
Practice Address - Street 2:SUITE 307
Practice Address - City:MONTEBELLO
Practice Address - State:CA
Practice Address - Zip Code:90640-4300
Practice Address - Country:US
Practice Address - Phone:323-888-2548
Practice Address - Fax:323-888-1741
Is Sole Proprietor?:No
Enumeration Date:2006-03-01
Last Update Date:2012-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA31712207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A317120Medicare ID - Type UnspecifiedMEDI-CAL PROVIDER NUMBER
CAE28291Medicare UPIN
CAW481Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER