Provider Demographics
NPI:1609051192
Name:QUERAL, CARMEN ALICIA (PA-C)
Entity Type:Individual
Prefix:MS
First Name:CARMEN
Middle Name:ALICIA
Last Name:QUERAL
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 1:7225 CRESCENT PARK W
Mailing Address - Street 2:APT 239
Mailing Address - City:PLAYA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:90094-2724
Mailing Address - Country:US
Mailing Address - Phone:818-510-4425
Mailing Address - Fax:
Practice Address - Street 1:11301 WILSHIRE BLVD.
Practice Address - Street 2:DEPT. OF VA--GREATER LOS ANGELES HEALTHCARE SYSTEM
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90073
Practice Address - Country:US
Practice Address - Phone:310-478-3711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-03
Last Update Date:2016-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA 11484363AM0700X
FLPA 910903363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical