Provider Demographics
NPI:1922216753
Name:ALDAMA, CAROLYN
Entity Type:Individual
Prefix:MS
First Name:CAROLYN
Middle Name:
Last Name:ALDAMA
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:CAROLYN
Other - Middle Name:JEAN
Other - Last Name:ALDAMA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:827 FORDHAM AVE
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93611-2024
Mailing Address - Country:US
Mailing Address - Phone:559-297-9047
Mailing Address - Fax:
Practice Address - Street 1:827 FORDHAM AVE
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93611-2024
Practice Address - Country:US
Practice Address - Phone:559-297-9047
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2009-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA530406163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse