Provider Demographics
NPI:1336139450
Name:CARLSON, JAMES E (MEDICAL DOCTOR)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:E
Last Name:CARLSON
Suffix:
Gender:M
Credentials:MEDICAL DOCTOR
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3801 LAS POSAS RD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93010-1427
Mailing Address - Country:US
Mailing Address - Phone:805-389-0099
Mailing Address - Fax:805-389-4884
Practice Address - Street 1:3801 LAS POSAS RD
Practice Address - Street 2:SUITE 106
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93010-1427
Practice Address - Country:US
Practice Address - Phone:805-389-0099
Practice Address - Fax:805-389-4884
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-28
Last Update Date:2012-05-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA26258207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A262580Medicaid
CAWA26258CMedicare PIN
CA00A262580Medicaid
CAA24784Medicare UPIN