Provider Demographics
NPI:1811917099
Name:CARMONA, MARILYN IDA (DC)
Entity type:Individual
Prefix:DR
First Name:MARILYN
Middle Name:IDA
Last Name:CARMONA
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1407 S B ST
Mailing Address - Street 2:STE #3
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94402-2433
Mailing Address - Country:US
Mailing Address - Phone:650-342-3452
Mailing Address - Fax:650-342-4087
Practice Address - Street 1:1407 S B ST
Practice Address - Street 2:STE #3
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94402-2433
Practice Address - Country:US
Practice Address - Phone:650-342-3452
Practice Address - Fax:650-342-4087
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2016-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15160111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic