Active NPI
Carole Sue Randolph, D.D.S, M.S.
- Orthodontics and Dentofacial Orthopedics Dentistry
- Valencia, CA
National Provider Identifier
1083876536
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Orthodontics and Dentofacial Orthopedics Dentistry
- License
- 33037
- Practice address
- 28212 Kelly Johnson Pkwy
Suite 100
Valencia, CA 91355-5084 - Phone
- (661) 222-3000
- NPI assigned
- Jun 26, 2008
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Orthodontics and Dentofacial Orthopedics Dentistry | 1223X0400X | 33037 | CA | Primary |
Addresses
Primary practice location
28212 Kelly Johnson Pkwy
Suite 100
Valencia, CA 91355-5084
Mailing address
28212 Kelly Johnson Pkwy
Suite 100
Valencia, CA 91355-5084
Phone (661) 222-3000
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
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 33037 | CA | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1214438400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1314144000000",
"number": "1083876536",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "28212 KELLY JOHNSON PKWY",
"address_2": "SUITE 100",
"city": "VALENCIA",
"state": "CA",
"postal_code": "913555084",
"telephone_number": "661-222-3000"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "28212 KELLY JOHNSON PKWY",
"address_2": "SUITE 100",
"city": "VALENCIA",
"state": "CA",
"postal_code": "913555084",
"telephone_number": "661-222-3000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RANDOLPH",
"first_name": "CAROLE",
"middle_name": "SUE",
"name_prefix": "Dr.",
"credential": "D.D.S, M.S.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-06-26",
"last_updated": "2011-08-24",
"status": "A"
},
"taxonomies": [
{
"code": "1223X0400X",
"taxonomy_group": "",
"desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
"state": "CA",
"license": "33037",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Valencia, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 24, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.