Provider Demographics
NPI:1376693952
Name:CARREON, MARISTELA MANUEL (MD)
Entity Type:Individual
Prefix:DR
First Name:MARISTELA
Middle Name:MANUEL
Last Name:CARREON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 E YOSEMITE AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95340-8220
Mailing Address - Country:US
Mailing Address - Phone:209-384-9108
Mailing Address - Fax:209-384-0580
Practice Address - Street 1:410 E YOSEMITE AVE
Practice Address - Street 2:SUITE A
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95340-8220
Practice Address - Country:US
Practice Address - Phone:209-384-9108
Practice Address - Fax:209-384-0580
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC50505207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C505050Medicaid
CAC50505OtherMEDICAL LICENSE
CAC50505OtherMEDICAL LICENSE
CA00C505050Medicaid