Provider Demographics
NPI:1710940044
Name:CARLSON, RHONDA LOUISE (MD)
Entity Type:Individual
Prefix:
First Name:RHONDA
Middle Name:LOUISE
Last Name:CARLSON
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 1:150 AMBER GROVE DR
Mailing Address - Street 2:SUITE 152
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95973-5879
Mailing Address - Country:US
Mailing Address - Phone:530-893-3575
Mailing Address - Fax:530-893-3758
Practice Address - Street 1:150 AMBER GROVE DR
Practice Address - Street 2:SUITE 152
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95973-5879
Practice Address - Country:US
Practice Address - Phone:530-893-3575
Practice Address - Fax:530-893-3758
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-08
Last Update Date:2016-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG70283207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP00248976OtherMEDICARE RAILROAD PTAN
CAP00248976OtherMEDICARE RAILROAD PTAN
CA00G702832Medicare PIN