Provider Demographics
NPI:1962673897
Name:DIMARUCOT, CAROLINE PETELO (MD)
Entity Type:Individual
Prefix:
First Name:CAROLINE
Middle Name:PETELO
Last Name:DIMARUCOT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1140 WEST LA PALMA AVE.
Mailing Address - Street 2:SUITE #6
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92801
Mailing Address - Country:US
Mailing Address - Phone:714-502-1144
Mailing Address - Fax:714-502-1146
Practice Address - Street 1:41715 WINCHESTER RD
Practice Address - Street 2:SUITE 201-B
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92590-4808
Practice Address - Country:US
Practice Address - Phone:951-296-2960
Practice Address - Fax:951-296-2962
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-19
Last Update Date:2008-03-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA86401208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics