Provider Demographics
NPI:1023037421
Name:PARRA, CAROLINE S (NP)
Entity Type:Individual
Prefix:MRS
First Name:CAROLINE
Middle Name:S
Last Name:PARRA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MRS
Other - First Name:CAROLINA
Other - Middle Name:S
Other - Last Name:PARRA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP
Mailing Address - Street 1:2820 ALUM ROCK AVE
Mailing Address - Street 2:SUITE #10
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95127-5608
Mailing Address - Country:US
Mailing Address - Phone:408-254-5040
Mailing Address - Fax:408-254-5044
Practice Address - Street 1:2820 ALUM ROCK AVE
Practice Address - Street 2:SUITE #10
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95127-5608
Practice Address - Country:US
Practice Address - Phone:408-254-5040
Practice Address - Fax:408-254-5044
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP15329363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMP1266837OtherDEA #
CAQ34819Medicare UPIN