Provider Demographics
NPI:1154659472
Name:VAN STRATEN, CAROLE A (HAD)
Entity Type:Individual
Prefix:MS
First Name:CAROLE
Middle Name:A
Last Name:VAN STRATEN
Suffix:
Gender:F
Credentials:HAD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:72301 COUNTRY CLUB DR
Mailing Address - Street 2:STE 112
Mailing Address - City:RANCHO MIRAGE
Mailing Address - State:CA
Mailing Address - Zip Code:92270-8007
Mailing Address - Country:US
Mailing Address - Phone:858-210-8154
Mailing Address - Fax:
Practice Address - Street 1:72301 COUNTRY CLUB DR
Practice Address - Street 2:STE 112
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270-8007
Practice Address - Country:US
Practice Address - Phone:858-210-8154
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-24
Last Update Date:2015-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHA7759237700000X, 237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist