Provider Demographics
NPI:1689997207
Name:CARVAJAL, KARINA YANNIN
Entity Type:Individual
Prefix:
First Name:KARINA
Middle Name:YANNIN
Last Name:CARVAJAL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 W BASTANCHURY RD
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92835-2502
Mailing Address - Country:US
Mailing Address - Phone:714-447-6527
Mailing Address - Fax:
Practice Address - Street 1:130 W BASTANCHURY RD
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92835-2502
Practice Address - Country:US
Practice Address - Phone:714-447-6527
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-10
Last Update Date:2010-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator