Provider Demographics
NPI:1609978592
Name:DOCHARTY, CARLA ISABEL (DPM)
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:ISABEL
Last Name:DOCHARTY
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3800 J ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95816-5551
Mailing Address - Country:US
Mailing Address - Phone:916-453-8900
Mailing Address - Fax:916-454-4359
Practice Address - Street 1:3800 J ST
Practice Address - Street 2:SUITE 200
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-5551
Practice Address - Country:US
Practice Address - Phone:916-453-8900
Practice Address - Fax:916-454-4359
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2013-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE3869213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000E38692Medicaid
CA480015328OtherOLD RR PROVIDER #
CAP00454692OtherRR INDIVIDUAL PROV. #
CA480015328OtherOLD RR PROVIDER #
CA1019100001Medicare NSC
CA000E38692Medicaid