Provider Demographics
NPI:1265089643
Name:MICHAEL, CARLA
Entity type:Individual
Prefix:
First Name:CARLA
Middle Name:
Last Name:MICHAEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2063 RANCHO VALLEY DR STE 329
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91766-7107
Mailing Address - Country:US
Mailing Address - Phone:909-480-1998
Mailing Address - Fax:
Practice Address - Street 1:2063 RANCHO VALLEY DR
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91766-7107
Practice Address - Country:US
Practice Address - Phone:099-991-9839
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-21
Last Update Date:2024-07-25
Deactivation Date:2019-08-21
Deactivation Code:
Reactivation Date:2023-12-05
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
No104100000XBehavioral Health & Social Service ProvidersSocial Worker