Provider Demographics
NPI:1992095905
Name:CARMONA, ROBERT ARTHUR (MASSAGE THERAPIST)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:ARTHUR
Last Name:CARMONA
Suffix:
Gender:M
Credentials:MASSAGE THERAPIST
Other - Prefix:MR
Other - First Name:ROBERT
Other - Middle Name:
Other - Last Name:CARMONA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CMT,
Mailing Address - Street 1:14626 VIA EL CAMINO
Mailing Address - Street 2:
Mailing Address - City:BALDWIN PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91706-2758
Mailing Address - Country:US
Mailing Address - Phone:310-877-0338
Mailing Address - Fax:
Practice Address - Street 1:14626 VIA EL CAMINO
Practice Address - Street 2:
Practice Address - City:BALDWIN PARK
Practice Address - State:CA
Practice Address - Zip Code:91706-2758
Practice Address - Country:US
Practice Address - Phone:310-877-0338
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-11
Last Update Date:2011-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15902225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1992095905Medicaid
CA1992095905Medicare Oscar/Certification
CA1992095905Medicare PIN
CA1992095905Medicare NSC
CA1992095905Medicare UPIN