Provider Demographics
NPI:1093935942
Name:CARNIVAL, PATRICIA L (MPT, OCS)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:L
Last Name:CARNIVAL
Suffix:
Gender:F
Credentials:MPT, OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5310 W 138TH ST
Mailing Address - Street 2:
Mailing Address - City:HAWTHORNE
Mailing Address - State:CA
Mailing Address - Zip Code:90250-6430
Mailing Address - Country:US
Mailing Address - Phone:310-245-5555
Mailing Address - Fax:
Practice Address - Street 1:5310 W 138TH ST
Practice Address - Street 2:
Practice Address - City:HAWTHORNE
Practice Address - State:CA
Practice Address - Zip Code:90250-6430
Practice Address - Country:US
Practice Address - Phone:310-245-5555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT24703174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT24703OtherPHYSICAL THERAPIST