Provider Demographics
NPI:1902824592
Name:CARLQUIST-HERNANDEZ, KAREN (EDD)
Entity Type:Individual
Prefix:DR
First Name:KAREN
Middle Name:
Last Name:CARLQUIST-HERNANDEZ
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3319 M ST
Mailing Address - Street 2:
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95348-2714
Mailing Address - Country:US
Mailing Address - Phone:209-385-3585
Mailing Address - Fax:209-385-3578
Practice Address - Street 1:3319 M ST
Practice Address - Street 2:
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95348-2714
Practice Address - Country:US
Practice Address - Phone:209-385-3585
Practice Address - Fax:209-385-3578
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2012-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY10848103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY10848OtherSTATE LICENSE NUMBER
CAPSY10848OtherSTATE LICENSE NUMBER