Provider Demographics
NPI:1912921685
Name:CHASE, CAROLYN F (MD)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:F
Last Name:CHASE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2953 TELEGRAPH RD
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-3214
Mailing Address - Country:US
Mailing Address - Phone:805-652-5252
Mailing Address - Fax:805-652-0097
Practice Address - Street 1:2953 TELEGRAPH RD STE 110
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-3214
Practice Address - Country:US
Practice Address - Phone:805-652-5252
Practice Address - Fax:833-916-2147
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2021-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG53838207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWG53838DMedicare ID - Type UnspecifiedTELEGRAPH LOCATION
CAE68421Medicare UPIN
CAWG53838CMedicare ID - Type UnspecifiedLOMA VISTA LOCATION