Provider Demographics
NPI:1366483430
Name:JOSE, CARMENCITA R (MD)
Entity Type:Individual
Prefix:DR
First Name:CARMENCITA
Middle Name:R
Last Name:JOSE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1600 9TH STREET
Mailing Address - Street 2:ROOM 205 MAILSTOP 2-3
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95814-6414
Mailing Address - Country:US
Mailing Address - Phone:916-654-2431
Mailing Address - Fax:916-654-3186
Practice Address - Street 1:2100 NAPA VALLEJO HIGHWAY
Practice Address - Street 2:
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94558-6293
Practice Address - Country:US
Practice Address - Phone:707-253-5000
Practice Address - Fax:707-253-5513
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2012-04-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAC385592084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry