Judee H Carrico

Individual provider Active NPI Other Specialist/Technologist · Montrose, CA

NPI 1801305503 · NPPES record last updated Sep 25, 2017

Key facts

NPI
1801305503
Entity type
Individual (NPI type 1)
Primary specialty
Other Specialist/Technologist 246Z00000X
Practice address
2032 Thompson CT Ste 12
Montrose, CA 91020-1652
Phone
(818) 249-5489
NPI assigned
Sep 25, 2017
Sex
Female
Sole proprietor
Yes

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Other Specialist/Technologist 246Z00000X Yes

Addresses

Primary practice location

2032 Thompson CT Ste 12
Montrose, CA 91020-1652

Mailing address

2746 El Caminito
La Crescenta, CA 91214-2932

Other identifiers

IdentifierTypeStateIssuer
6253OtherCAELECTROLOGIST LICENSE

Other providers in Montrose, CA

All providers in Montrose, CA · Other Specialist/Technologist in California

Sources for this page

Verify at the official NPI Registry.