Provider Demographics
NPI:1407224611
Name:BACH, CARRIE (RN, PHN)
Entity Type:Individual
Prefix:MRS
First Name:CARRIE
Middle Name:
Last Name:BACH
Suffix:
Gender:F
Credentials:RN, PHN
Other - Prefix:
Other - First Name:CARRIE
Other - Middle Name:
Other - Last Name:SELZER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:241 N FIGUEROA ST
Mailing Address - Street 2:SUITE 306
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90012-2601
Mailing Address - Country:US
Mailing Address - Phone:213-240-7944
Mailing Address - Fax:213-250-8634
Practice Address - Street 1:241 N FIGUEROA ST
Practice Address - Street 2:SUITE 306
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90012-2601
Practice Address - Country:US
Practice Address - Phone:213-240-7944
Practice Address - Fax:213-250-8634
Is Sole Proprietor?:No
Enumeration Date:2015-09-03
Last Update Date:2015-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA503033163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse