1215987540 NPI number — DR. MARY ANN PELINO CARROLL M.D.

Table of content: DR. MARY ANN PELINO CARROLL M.D. (NPI 1215987540)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215987540 NPI number — DR. MARY ANN PELINO CARROLL M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PELINO CARROLL
Provider First Name:
MARY ANN
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PELINO
Provider Other First Name:
MARYANN
Provider Other Middle Name:
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1215987540
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6650 ALTON PARKWAY, 3RD FLOOR
Provider Second Line Business Mailing Address:
KAISER PERMANENTE ORANGE COUNTY OBSTETRICS & GYNECOLOGY
Provider Business Mailing Address City Name:
IRVINE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92618
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6650 ALTON PARKWAY, MOB2 3RD FLOOR
Provider Second Line Business Practice Location Address:
KAISER PERMANENTE OBSTETRICS & GYNECOLOGY
Provider Business Practice Location Address City Name:
IRVINE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92618
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
949-932-5655
Provider Business Practice Location Address Fax Number:
949-932-6348
Provider Enumeration Date:
05/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  A76094 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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