Provider Demographics
NPI:1326321399
Name:CARROLL, VERNELL
Entity Type:Individual
Prefix:
First Name:VERNELL
Middle Name:
Last Name:CARROLL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1609 E PALMDALE
Mailing Address - Street 2:SUITE G
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93550-4881
Mailing Address - Country:US
Mailing Address - Phone:805-886-5660
Mailing Address - Fax:661-272-0415
Practice Address - Street 1:1609 E PALMDALE BLVD
Practice Address - Street 2:SUITE G
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93550-4881
Practice Address - Country:US
Practice Address - Phone:661-947-1595
Practice Address - Fax:661-272-0415
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-26
Last Update Date:2011-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator