Provider Demographics
NPI:1780693168
Name:CAROL HUMBLE M.D. INC.
Entity type:Organization
Organization Name:CAROL HUMBLE M.D. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:MARY
Authorized Official - Last Name:HUMBLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-795-6596
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-05
Last Update Date:2007-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G492410OtherBLUE SHIELD
CA00G492410Medicaid
CA00G492410Medicaid
CAWG49241BMedicare PIN
CAW17312Medicare PIN