# ERICK F. CARCAMO A PROFESSIONAL MEDICAL CORPORATION

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** ERICK F. CARCAMO MD
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1457594939
- **Legal business name:** ERICK F. CARCAMO MD
- **Authorized official:** ERICK F CARCAMO MD (MEDICAL DOCAATOR)
- **Authorized official phone:** (626) 337-1360

## Contact information

- **Practice address:** 14650 PACIFIC AVE, BALDWIN PARK, CA 91706-5333
- **Practice address phone:** (626) 337-1360
- **Practice address fax:** (626) 338-3861
- **Mailing address:** 14307 RAMONA BLVD, BALDWIN PARK, CA 91706-3242
- **Mailing address phone:** (626) 337-1360
- **Mailing address fax:** (626) 338-3861

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | A53329 | CA | Yes |

## Other

- **Enumeration date:** 04/13/2009
- **Last updated:** 06/17/2019

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 00A533290 | — | CA |
| 01 | — | 05D0906608 | CLIA | CA |