Provider Demographics
NPI:1255697496
Name:FUNK, CAROLINA (RN)
Entity type:Individual
Prefix:MRS
First Name:CAROLINA
Middle Name:
Last Name:FUNK
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23601 AVALON BLVD
Mailing Address - Street 2:SUITE # 207
Mailing Address - City:CARSON
Mailing Address - State:CA
Mailing Address - Zip Code:90745
Mailing Address - Country:US
Mailing Address - Phone:310-513-0687
Mailing Address - Fax:310-513-0689
Practice Address - Street 1:23601 AVALON BLVD
Practice Address - Street 2:SUITE # 207
Practice Address - City:CARSON
Practice Address - State:CA
Practice Address - Zip Code:90745
Practice Address - Country:US
Practice Address - Phone:310-513-0687
Practice Address - Fax:310-513-0689
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-02
Last Update Date:2012-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA769604163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse