Provider Demographics
NPI:1225750847
Name:WADE, CAROLINA ANGELICA
Entity Type:Individual
Prefix:
First Name:CAROLINA
Middle Name:ANGELICA
Last Name:WADE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CAROLINA
Other - Middle Name:ANGELICA
Other - Last Name:GIRDWOOD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3628 MADISON AVE STE 6
Mailing Address - Street 2:
Mailing Address - City:NORTH HIGHLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:95660-5070
Mailing Address - Country:US
Mailing Address - Phone:916-388-3231
Mailing Address - Fax:
Practice Address - Street 1:3628 MADISON AVE STE 6
Practice Address - Street 2:
Practice Address - City:NORTH HIGHLANDS
Practice Address - State:CA
Practice Address - Zip Code:95660-5070
Practice Address - Country:US
Practice Address - Phone:916-388-3231
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-12
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator