Provider Demographics
NPI:1740413517
Name:DR CAROLYN R TOWLER MD A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:DR CAROLYN R TOWLER MD A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:R
Authorized Official - Last Name:TOWLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:213-480-0072
Mailing Address - Street 1:2520 W 6TH ST
Mailing Address - Street 2:#107
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90057-3174
Mailing Address - Country:US
Mailing Address - Phone:213-480-0072
Mailing Address - Fax:213-480-0092
Practice Address - Street 1:2520 W 6TH ST
Practice Address - Street 2:#107
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90057-3174
Practice Address - Country:US
Practice Address - Phone:213-480-0072
Practice Address - Fax:213-480-0092
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-27
Last Update Date:2009-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
F29614Medicare UPIN