Provider Demographics
NPI:1659467405
Name:CARLTON, CHRISTINA MARSA (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTINA
Middle Name:MARSA
Last Name:CARLTON
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 1:1415 NORTH STREET
Mailing Address - Street 2:
Mailing Address - City:SUSANVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:96130-4055
Mailing Address - Country:US
Mailing Address - Phone:530-257-9293
Mailing Address - Fax:
Practice Address - Street 1:795 JOAQUIN STREET
Practice Address - Street 2:
Practice Address - City:SUSANVILLE
Practice Address - State:CA
Practice Address - Zip Code:96130
Practice Address - Country:US
Practice Address - Phone:530-257-2542
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2007-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA063737208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH12087Medicare UPIN