Provider Demographics
NPI:1255374245
Name:ENGEL, CAROL (FNP)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:
Last Name:ENGEL
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66731 CASA GRANDE
Mailing Address - Street 2:
Mailing Address - City:DESERT HOT SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92240-1801
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:HI-DESERT MEDICAL CENTER
Practice Address - Street 2:6601 WHITE FEATHER ROAD
Practice Address - City:JOSHUA TREE
Practice Address - State:CA
Practice Address - Zip Code:92252
Practice Address - Country:US
Practice Address - Phone:760-366-2711
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-14
Last Update Date:2011-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1448207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAQ15318Medicare UPIN
CAZZZ30804ZMedicare ID - Type Unspecified