Bastardo, Carlos

Bastardo, Carlos is an individual health care provider with primary practice located at 11191 Shadylane Dr , Plymouth IN 46563-8623. He recently has only one registered license in Other Service Providers / Prevention Professional, which is considered as his primary health care specialty. Bastardo, Carlos can be contacted via phone (574) 936-4152.

Contact Information

Primary practice address
11191 Shadylane Dr Plymouth IN 46563-8623
Phone: (574) 936-4152
Fax: (312) 256-9390
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Other Service Providers / Prevention Professional 405300000X 3577690 Indiana

Profile Details

NPI number 1417492281
LBN Legal business name Bastardo, Carlos
Credentials
Entity Individual
Sole proprietor 1 No
Enumeration date Jan 3rd, 2017
Last updated Jan 3rd, 2017 - about 9 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1417492281 NPPES
Indiana Other 3577690 NATIONAL PRODUCER NUMBER

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