Provider Demographics
NPI:1649819285
Name:CARBON HEALTH MEDICAL GROUP OF CALIFORNIA PC
Entity type:Organization
Organization Name:CARBON HEALTH MEDICAL GROUP OF CALIFORNIA PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEAD OF REVENUEDIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KAITLIN
Authorized Official - Middle Name:
Authorized Official - Last Name:BOYLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-601-5392
Mailing Address - Street 1:6971 EL CAMINO REAL STE 101
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92009-4114
Mailing Address - Country:US
Mailing Address - Phone:760-603-3221
Mailing Address - Fax:888-972-1912
Practice Address - Street 1:6971 EL CAMINO REAL STE 101
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92009-4114
Practice Address - Country:US
Practice Address - Phone:760-603-3221
Practice Address - Fax:888-972-1912
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DIRECT URGENT CARE INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-12-30
Last Update Date:2024-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Multi-Specialty
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent CareGroup - Multi-Specialty