Provider Demographics
NPI:1770350852
Name:CARLSON, DAVID
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:CARLSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1650 HICKORY WOOD LN
Mailing Address - Street 2:
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92545-8069
Mailing Address - Country:US
Mailing Address - Phone:951-795-1623
Mailing Address - Fax:
Practice Address - Street 1:1650 HICKORY WOOD LN
Practice Address - Street 2:
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92545-8069
Practice Address - Country:US
Practice Address - Phone:951-795-1623
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-07
Last Update Date:2023-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility