Provider Demographics
NPI:1760594733
Name:KOLESNIK, CARLETTE SPENGLER (PA-C)
Entity Type:Individual
Prefix:MS
First Name:CARLETTE
Middle Name:SPENGLER
Last Name:KOLESNIK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:CARLETTE
Other - Middle Name:MARIE
Other - Last Name:KOLESNIK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:2468 SAN ANTONIO CRES E
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91784-1180
Mailing Address - Country:US
Mailing Address - Phone:909-946-8737
Mailing Address - Fax:909-982-1776
Practice Address - Street 1:9961 SIERRA AVE
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92335-6720
Practice Address - Country:US
Practice Address - Phone:909-427-5402
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2021-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA10850363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAS67972Medicare UPIN