Provider Demographics
NPI:1659590883
Name:DOYLE, CARMEN OLIVIA (PA-C)
Entity Type:Individual
Prefix:
First Name:CARMEN
Middle Name:OLIVIA
Last Name:DOYLE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:CARMEN
Other - Middle Name:OLIVIA
Other - Last Name:OSEGUERA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:5901 CLOVER HEIGHTS AVE
Mailing Address - Street 2:
Mailing Address - City:MALIBU
Mailing Address - State:CA
Mailing Address - Zip Code:90265-3704
Mailing Address - Country:US
Mailing Address - Phone:323-646-8102
Mailing Address - Fax:
Practice Address - Street 1:1500 SAN PABLO ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033-5313
Practice Address - Country:US
Practice Address - Phone:323-442-5790
Practice Address - Fax:323-442-7699
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2014-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19035363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant