Provider Demographics
NPI:1649234733
Name:FOX, CARLA G (MD)
Entity Type:Individual
Prefix:DR
First Name:CARLA
Middle Name:G
Last Name:FOX
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11440 SIR FRANCIS DRAKE DR
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91941-7266
Mailing Address - Country:US
Mailing Address - Phone:619-251-8625
Mailing Address - Fax:
Practice Address - Street 1:11440 SIR FRANCIS DRAKE DR
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91941-7266
Practice Address - Country:US
Practice Address - Phone:619-251-8625
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2022-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG39405207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACP8881OtherPALMETTO GBA-RAILROAD MED
CAGR0028400Medicaid
CAA47814Medicare UPIN
CACP8881OtherPALMETTO GBA-RAILROAD MED