Provider Demographics
NPI:1407318314
Name:CARPIO, MARLON HERRERA (FNP)
Entity Type:Individual
Prefix:MR
First Name:MARLON
Middle Name:HERRERA
Last Name:CARPIO
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 PACIFIC CRST
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92602-2408
Mailing Address - Country:US
Mailing Address - Phone:909-282-0794
Mailing Address - Fax:
Practice Address - Street 1:17 PACIFIC CRST
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92602-2408
Practice Address - Country:US
Practice Address - Phone:909-282-0794
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-01
Last Update Date:2019-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN586573363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily