Provider Demographics
NPI:1043365760
Name:HSU, CARMEN PHILOMENA (M D)
Entity Type:Individual
Prefix:
First Name:CARMEN
Middle Name:PHILOMENA
Last Name:HSU
Suffix:
Gender:F
Credentials:M D
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1816 16TH AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95062-1709
Mailing Address - Country:US
Mailing Address - Phone:831-728-2969
Mailing Address - Fax:831-722-9604
Practice Address - Street 1:222 GREEN VALLEY RD
Practice Address - Street 2:
Practice Address - City:FREEDOM
Practice Address - State:CA
Practice Address - Zip Code:95019-3136
Practice Address - Country:US
Practice Address - Phone:831-728-2969
Practice Address - Fax:831-722-9604
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2017-01-31
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG83166208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG83166OtherSTATE LICENSE