Provider Demographics
NPI:1033504709
Name:APEZZATO, CARLA ALESSANDRA (MD)
Entity Type:Individual
Prefix:
First Name:CARLA ALESSANDRA
Middle Name:
Last Name:APEZZATO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3786 S PIMMIT AVE
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83706-6417
Mailing Address - Country:US
Mailing Address - Phone:208-391-8587
Mailing Address - Fax:
Practice Address - Street 1:500 W FORT ST
Practice Address - Street 2:111R
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702
Practice Address - Country:US
Practice Address - Phone:208-422-1314
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-31
Last Update Date:2018-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM-14297207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine