Provider Demographics
NPI:1487031654
Name:BAGSHAW, CAROLINE (DVM)
Entity Type:Individual
Prefix:DR
First Name:CAROLINE
Middle Name:
Last Name:BAGSHAW
Suffix:
Gender:F
Credentials:DVM
Other - Prefix:DR
Other - First Name:CARRIE
Other - Middle Name:
Other - Last Name:BAGSHAW
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DVM
Mailing Address - Street 1:6455 SANTA MONICA BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90038-2910
Mailing Address - Country:US
Mailing Address - Phone:323-919-6666
Mailing Address - Fax:323-672-8488
Practice Address - Street 1:6455 SANTA MONICA BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90038-2910
Practice Address - Country:US
Practice Address - Phone:323-919-6666
Practice Address - Fax:323-672-8488
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-27
Last Update Date:2016-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17638174M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174M00000XOther Service ProvidersVeterinarian