Provider Demographics
NPI:1457367906
Name:HUMBLE, CAROL MARY (MD)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:MARY
Last Name:HUMBLE
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 1:225 S LAKE AVE
Mailing Address - Street 2:535
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91101-3005
Mailing Address - Country:US
Mailing Address - Phone:626-795-6596
Mailing Address - Fax:626-795-8247
Practice Address - Street 1:255 E SANTA CLARA ST
Practice Address - Street 2:240
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91006-7226
Practice Address - Country:US
Practice Address - Phone:626-254-1800
Practice Address - Fax:626-447-7145
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2007-09-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG49241207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G492410OtherBLUE SHIELD
CA00G492410Medicaid
CAWG49241AMedicare ID - Type Unspecified
A92883Medicare UPIN
CAWG49241BMedicare PIN