Provider Demographics
NPI:1205181385
Name:CARPENTER, ANNETTE (BA)
Entity Type:Individual
Prefix:
First Name:ANNETTE
Middle Name:
Last Name:CARPENTER
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:ANNETTE
Other - Middle Name:
Other - Last Name:GARCILAZO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BA
Mailing Address - Street 1:60440 GRANADA DR
Mailing Address - Street 2:
Mailing Address - City:JOSHUA TREE
Mailing Address - State:CA
Mailing Address - Zip Code:92252-2761
Mailing Address - Country:US
Mailing Address - Phone:760-217-2775
Mailing Address - Fax:
Practice Address - Street 1:58923 BUSINESS CENTER DR
Practice Address - Street 2:STE. E
Practice Address - City:YUCCA VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92284-7311
Practice Address - Country:US
Practice Address - Phone:760-228-7209
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-16
Last Update Date:2015-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator