Active NPI
Craig John Carbonniere Sr., P.A.
- Physician Assistant
- Lakewood, CA
National Provider Identifier
1063578110
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA10492
- Practice address
- 5203 Lakewood Blvd
Lakewood, CA 90712-2438 - Phone
- (562) 633-2273
- NPI assigned
- Dec 30, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA10492 | CA | Primary |
Addresses
Primary practice location
5203 Lakewood Blvd
Lakewood, CA 90712-2438
Mailing address
7692 Ellis Ave
Huntington Beach, CA 92648-1635
Phone (909) 217-4321
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA10492 | CA | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1167436800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1436918400000",
"number": "1063578110",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7692 ELLIS AVE",
"city": "HUNTINGTON BEACH",
"state": "CA",
"postal_code": "926481635",
"telephone_number": "909-217-4321"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5203 LAKEWOOD BLVD",
"city": "LAKEWOOD",
"state": "CA",
"postal_code": "907122438",
"telephone_number": "562-633-2273"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CARBONNIERE",
"first_name": "CRAIG",
"middle_name": "JOHN",
"name_prefix": "Mr.",
"name_suffix": "Sr.",
"credential": "P.A.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-12-30",
"last_updated": "2015-07-15",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "CA",
"license": "PA10492",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lakewood, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.