Provider Demographics
NPI:1043409956
Name:CONBOY, CAROLYN JEAN (DO)
Entity Type:Individual
Prefix:DR
First Name:CAROLYN
Middle Name:JEAN
Last Name:CONBOY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:955 CARRILLO DR STE 105
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-5400
Mailing Address - Country:US
Mailing Address - Phone:323-934-4266
Mailing Address - Fax:
Practice Address - Street 1:955 CARRILLO DR STE 105
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-5400
Practice Address - Country:US
Practice Address - Phone:323-934-4266
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-16
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A9162208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery