Provider Demographics
NPI:1982890042
Name:MULL, CARLA ALLISON (PA-C)
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:ALLISON
Last Name:MULL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2660 E MAIN ST STE 100
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-2893
Mailing Address - Country:US
Mailing Address - Phone:626-848-8383
Mailing Address - Fax:
Practice Address - Street 1:2660 E MAIN ST STE 100
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-2893
Practice Address - Country:US
Practice Address - Phone:626-848-8383
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-21
Last Update Date:2018-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA19160363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0061190Medicaid
CAW12122OtherMEDICARE GROUP NUMBER
CAGR0061200Medicaid
CAW12122AOtherMEDICARE GROUP NUMBER