Provider Demographics
NPI:1669693156
Name:CARLSBERG, DEANNA (PA-C)
Entity type:Individual
Prefix:
First Name:DEANNA
Middle Name:
Last Name:CARLSBERG
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32505 GALATINA ST
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92592-3880
Mailing Address - Country:US
Mailing Address - Phone:714-851-3672
Mailing Address - Fax:
Practice Address - Street 1:32505 GALATINA ST
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92592-3880
Practice Address - Country:US
Practice Address - Phone:714-851-3672
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA 15267363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPA 15267Medicare UPIN