Provider Demographics
NPI:1093600488
Name:CARBAJAL, LOURDES
Entity type:Individual
Prefix:
First Name:LOURDES
Middle Name:
Last Name:CARBAJAL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LOURDES
Other - Middle Name:
Other - Last Name:RIVERA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:21250 BOX SPRINGS RD STE 212
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92557-8712
Mailing Address - Country:US
Mailing Address - Phone:951-686-1096
Mailing Address - Fax:
Practice Address - Street 1:21250 BOX SPRINGS RD STE 212
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92557-8712
Practice Address - Country:US
Practice Address - Phone:951-686-1096
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-09
Last Update Date:2025-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker