Provider Demographics
NPI:1689890097
Name:DEFRAINE, CARLA S (PDD)
Entity Type:Individual
Prefix:DR
First Name:CARLA
Middle Name:S
Last Name:DEFRAINE
Suffix:
Gender:F
Credentials:PDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 CALLE CABRILLO
Mailing Address - Street 2:
Mailing Address - City:FOOTHILL RANCH
Mailing Address - State:CA
Mailing Address - Zip Code:92610-1747
Mailing Address - Country:US
Mailing Address - Phone:949-859-1601
Mailing Address - Fax:
Practice Address - Street 1:13441 RANCHO SANTA MARGARITA PARKWAY
Practice Address - Street 2:SUITE B
Practice Address - City:RANCHO SANTA MARGARITA
Practice Address - State:CA
Practice Address - Zip Code:92688
Practice Address - Country:US
Practice Address - Phone:949-709-7091
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY21319103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY21319OtherCALIF LIC