NPI 1417492281

Carlos Bastardo

Practitioner Prevention Professional Plymouth, IN

Practice location

Address: 11191 Shadylane Dr, Plymouth, IN 46563-8623
Phone: (574) 936-4152
Fax: (312) 256-9390

Registered specialties

Prevention Professional Primary

Other Service Providers Taxonomy 405300000X Licence 3577690 (IN)

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Registry record

NPI: 1417492281
Entity type: Individual
Sex (as registered): Male
NPI issued: 3 Jan 2017
Record last updated: 3 Jan 2017

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.