Provider Demographics
NPI:1518215375
Name:CARBONA, ROCIO VERONICA (PA-C)
Entity Type:Individual
Prefix:
First Name:ROCIO VERONICA
Middle Name:
Last Name:CARBONA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1138 MAIN ST # 562
Mailing Address - Street 2:
Mailing Address - City:READFIELD
Mailing Address - State:ME
Mailing Address - Zip Code:04355-9998
Mailing Address - Country:US
Mailing Address - Phone:917-532-0350
Mailing Address - Fax:
Practice Address - Street 1:9 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:ME
Practice Address - Zip Code:04963-5074
Practice Address - Country:US
Practice Address - Phone:207-465-2138
Practice Address - Fax:207-465-4629
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-27
Last Update Date:2012-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPA1351363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical