1538490107 NPI number — CINDY ALBERTS CARSON MD INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538490107 NPI number — CINDY ALBERTS CARSON MD INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CINDY ALBERTS CARSON MD INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1538490107
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/18/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
625 SO FAIROAKS AVE
Provider Second Line Business Mailing Address:
SUITE 245
Provider Business Mailing Address City Name:
PASADENA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91105-2615
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
888-702-4557
Provider Business Mailing Address Fax Number:
925-790-0764

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
625 SO FAIROAKS AVE
Provider Second Line Business Practice Location Address:
SUITE 245
Provider Business Practice Location Address City Name:
PASADENA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91105-2615
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
626-229-9865
Provider Business Practice Location Address Fax Number:
626-229-9867
Provider Enumeration Date:
01/21/2010

Additional Information

Authorized Official

Authorized Official Last Name:
CARSON
Authorized Official First Name:
CINDY
Authorized Official Middle Name:
A
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
888-702-4557

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  A101515 , 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)

  • Identifier: A101515 . This is a "CA MEDICAL LICENSE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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