Provider Demographics
NPI:1245400548
Name:CARREON, CAROLINE CAVA (PTA)
Entity Type:Individual
Prefix:
First Name:CAROLINE
Middle Name:CAVA
Last Name:CARREON
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:CAROLINE
Other - Middle Name:A
Other - Last Name:CAVA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7933 WESTMORE RD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92126-2205
Mailing Address - Country:US
Mailing Address - Phone:858-689-2361
Mailing Address - Fax:
Practice Address - Street 1:7933 WESTMORE RD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92126-2205
Practice Address - Country:US
Practice Address - Phone:858-689-2361
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-03
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAT8323225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant