Provider Demographics
NPI:1497046361
Name:CARR, KAYLENE R (MD)
Entity Type:Individual
Prefix:
First Name:KAYLENE
Middle Name:R
Last Name:CARR
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:6767 BROCKTON AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92506-3023
Mailing Address - Country:US
Mailing Address - Phone:951-823-0441
Mailing Address - Fax:951-823-0447
Practice Address - Street 1:1800 N. WESTERN AVE STE 204
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92411-1353
Practice Address - Country:US
Practice Address - Phone:909-474-9952
Practice Address - Fax:909-474-9951
Is Sole Proprietor?:No
Enumeration Date:2011-04-27
Last Update Date:2019-04-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA124094174400000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No174400000XOther Service ProvidersSpecialist