Provider Demographics
NPI:1801575253
Name:PRINA, CAROLYN JO (PA-C)
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:JO
Last Name:PRINA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4620 SAN ANTONIO RD
Mailing Address - Street 2:
Mailing Address - City:YORBA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92886-7338
Mailing Address - Country:US
Mailing Address - Phone:714-296-7124
Mailing Address - Fax:
Practice Address - Street 1:8170 LAGUNA BLVD STE 113
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95758-7902
Practice Address - Country:US
Practice Address - Phone:916-478-6561
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-13
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPA63000363AM0700X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical