Provider Demographics
NPI:1518403591
Name:CARBAJAL, JOSIE CARMEN (BS)
Entity Type:Individual
Prefix:MS
First Name:JOSIE
Middle Name:CARMEN
Last Name:CARBAJAL
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1325 N WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90027-5615
Mailing Address - Country:US
Mailing Address - Phone:323-461-3131
Mailing Address - Fax:323-957-2464
Practice Address - Street 1:1325 N WESTERN AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027-5615
Practice Address - Country:US
Practice Address - Phone:323-461-3131
Practice Address - Fax:323-957-2464
Is Sole Proprietor?:No
Enumeration Date:2017-01-13
Last Update Date:2017-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator