Provider Demographics
NPI:1083816508
Name:HAUSER, CAROLE JEAN (MD)
Entity Type:Individual
Prefix:
First Name:CAROLE
Middle Name:JEAN
Last Name:HAUSER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CAROLE
Other - Middle Name:HAUSER
Other - Last Name:PRIKOSOVITS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3701 SKYPARK DR STE 100
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-4712
Mailing Address - Country:US
Mailing Address - Phone:310-378-2234
Mailing Address - Fax:
Practice Address - Street 1:3701 SKYPARK DR STE 100
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505
Practice Address - Country:US
Practice Address - Phone:310-378-2234
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-05
Last Update Date:2022-07-21
Deactivation Date:2015-11-10
Deactivation Code:
Reactivation Date:2017-07-18
Provider Licenses
StateLicense IDTaxonomies
TX45978207R00000X
CAA055345207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG64908Medicare UPIN