Active NPI
Gardner Carlson
- Licensed Psychiatric Technician
- Santa Rosa, CA
National Provider Identifier
1063977460
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Licensed Psychiatric Technician
- License
- 31251
- Practice address
- 2225 Challenger Way
Santa Rosa, CA 95407-5441 - Phone
- (707) 565-4970
- Fax
- (707) 565-5183
- NPI assigned
- Feb 10, 2019
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Licensed Psychiatric Technician | 167G00000X | 31251 | CA | Primary |
Addresses
Primary practice location
2225 Challenger Way
Santa Rosa, CA 95407-5441
Mailing address
2225 Challenger Way
Santa Rosa, CA 95407-5441
Phone (707) 565-4970
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 31251 | CA | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1549756800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1549756800000",
"number": "1063977460",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2225 CHALLENGER WAY",
"city": "SANTA ROSA",
"state": "CA",
"postal_code": "954075441",
"telephone_number": "707-565-4970",
"fax_number": "707-565-5183"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2225 CHALLENGER WAY",
"city": "SANTA ROSA",
"state": "CA",
"postal_code": "954075441",
"telephone_number": "707-565-4970",
"fax_number": "707-565-5183"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CARLSON",
"first_name": "GARDNER",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2019-02-10",
"last_updated": "2019-02-10",
"status": "A"
},
"taxonomies": [
{
"code": "167G00000X",
"taxonomy_group": "",
"desc": "Licensed Psychiatric Technician",
"state": "CA",
"license": "31251",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Santa Rosa, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 10, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.