Provider Demographics
NPI:1245673334
Name:AISEN, CARRIE (MD)
Entity type:Individual
Prefix:DR
First Name:CARRIE
Middle Name:
Last Name:AISEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8881 FLETCHER PKWY STE 250
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-3191
Mailing Address - Country:US
Mailing Address - Phone:619-828-1000
Mailing Address - Fax:
Practice Address - Street 1:8881 FLETCHER PKWY STE 250
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-3191
Practice Address - Country:US
Practice Address - Phone:619-828-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-09
Last Update Date:2019-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA161915208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology