Provider Demographics
NPI:1487862678
Name:CHOMKA, CARLA (PHD)
Entity Type:Individual
Prefix:DR
First Name:CARLA
Middle Name:
Last Name:CHOMKA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:CARLA
Other - Middle Name:
Other - Last Name:ISON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:PO BOX 60401
Mailing Address - Street 2:
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94306-0401
Mailing Address - Country:US
Mailing Address - Phone:650-332-4655
Mailing Address - Fax:
Practice Address - Street 1:441 S CALIFORNIA AVE
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94306-1847
Practice Address - Country:US
Practice Address - Phone:650-332-4655
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-19
Last Update Date:2018-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19759103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical