Provider Demographics
NPI:1558319293
Name:INOCENCIO, CARLOS F (MD)
Entity type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:F
Last Name:INOCENCIO
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 1:501 S ALTA AVE
Mailing Address - Street 2:
Mailing Address - City:DINUBA
Mailing Address - State:CA
Mailing Address - Zip Code:93618-2100
Mailing Address - Country:US
Mailing Address - Phone:559-315-2588
Mailing Address - Fax:866-493-3746
Practice Address - Street 1:501 S ALTA AVE
Practice Address - Street 2:
Practice Address - City:DINUBA
Practice Address - State:CA
Practice Address - Zip Code:93618-2100
Practice Address - Country:US
Practice Address - Phone:559-315-2588
Practice Address - Fax:866-493-3746
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-05
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG45595208D00000X
NV9971207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002018695Medicaid
35592Medicare ID - Type Unspecified
A50109Medicare UPIN
NVBH351XMedicare PIN
NV002018695Medicaid