Provider Demographics
NPI:1427211150
Name:CARPENTER, HENRY JAY (DPO)
Entity Type:Individual
Prefix:
First Name:HENRY
Middle Name:JAY
Last Name:CARPENTER
Suffix:
Gender:M
Credentials:DPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42011 4TH ST W STE 1900
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93534-7185
Mailing Address - Country:US
Mailing Address - Phone:661-974-7562
Mailing Address - Fax:
Practice Address - Street 1:42011 4TH ST W STE 1900
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-7185
Practice Address - Country:US
Practice Address - Phone:661-974-7562
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-02
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator