Active NPI
Carol Joy Provan
- Pediatrics Physician
- Redwood City, CA
National Provider Identifier
1780736041
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- A25599
- Practice address
- 2710 Middlefield Rd
Redwood City, CA 94063-3404 - Phone
- (650) 573-2222
- NPI assigned
- Jan 17, 2007
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | A25599 | CA | Primary |
Addresses
Primary practice location
2710 Middlefield Rd
Redwood City, CA 94063-3404
Mailing address
2710 Middlefield Rd
Fair Oaks Childrens Clinic
Redwood City, CA 94063
Phone (650) 573-2222
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00A255990 | Medicaid | CA |
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 |
|---|---|---|---|
| A25599 | CA | MD | Pediatrics Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1168992000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1780736041",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2710 MIDDLEFIELD RD",
"address_2": "FAIR OAKS CHILDRENS CLINIC",
"city": "REDWOOD CITY",
"state": "CA",
"postal_code": "94063",
"telephone_number": "650-573-2222"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2710 MIDDLEFIELD RD",
"city": "REDWOOD CITY",
"state": "CA",
"postal_code": "940633404",
"telephone_number": "650-573-2222"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PROVAN",
"first_name": "CAROL",
"middle_name": "JOY",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-01-17",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "CA",
"license": "A25599",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00A255990",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Redwood City, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.