Provider Demographics
NPI:1982130654
Name:CARPIO, MARY GRACE G
Entity Type:Individual
Prefix:
First Name:MARY GRACE
Middle Name:G
Last Name:CARPIO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:702 PAULSEN AVE
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92020-7346
Mailing Address - Country:US
Mailing Address - Phone:619-212-0264
Mailing Address - Fax:
Practice Address - Street 1:702 PAULSEN AVE
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92020-7346
Practice Address - Country:US
Practice Address - Phone:619-212-0264
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-02
Last Update Date:2017-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00275010374U00000X
CA00922367376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
No374U00000XNursing Service Related ProvidersHome Health Aide