MR. CARLOS BASTARDO NPI 1417492281

NPI Information

  • NPI: 1417492281
  • Provider Name: MR. CARLOS BASTARDO
  • Classification: Prevention Professional - 405300000X
  • Entity Type: Individual
  • Address: 11191 SHADYLANE DR
    PLYMOUTH, IN
    ZIP 46563
  • Phone: (574) 936-4152

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NPI Details

MR. Carlos Bastardo is a prevention professional in Plymouth, IN. The provider is prevention Professionals work in programs aimed to address specific patient needs, such as suicide prevention, violence prevention, alcohol avoidance, drug avoidance, and tobacco prevention. The goal of the program is to reduce the risk of relapse, injury, or re-injury of the patient. Prevention Professionals work in a variety of settings and provide appropriate case management, mediation, referral, and mentorship services. Individuals complete prevention professionals training for the population of patients with whom they work. MR. Carlos Bastardo NPI is 1417492281. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

11191 SHADYLANE DR
PLYMOUTH, IN
ZIP 46563-623
Phone: (574) 936-4152
Fax: (312) 256-9390

The enumeration date for this NPI number is 1/3/2017 and was last updated on 1/3/2017.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1405300000XPrevention Professional3577690INDIANAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
13577690OTHERINDIANANATIONAL PRODUCER NUMBER

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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