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MR. CRAIG JOHN CARBONNIERE P.A.
>> Physician Assistant >> Physician Assistants & Advanced Practice Nursing ProvidersRegistrant NPI Number: 1063578110
Individual Registrant:MR. CRAIG JOHN CARBONNIERE P.A.
Gender: M
Sole Proprietor
Gender: M
Sole Proprietor
Location and contact information for practice:
5203 LAKEWOOD BLVD LAKEWOOD, CA 90712-2438 US
Tel: 562-633-2273 Fax: --
Tel: 562-633-2273 Fax: --
Contact information for business:
7692 ELLIS AVE HUNTINGTON BEACH, CA 92648-1635 US
Tel: 909-217-4321 Fax: --
Tel: 909-217-4321 Fax: --
Registration Information:
NPI: 1063578110
Entity Type: Individual
Entity Type: Individual
Specialty information:
| Primary | Code | Category/Description | State | License Number |
|---|---|---|---|---|
| Y | 363A00000X | Physician Assistants & Advanced Practice Nursing Providers Physician Assistant | CA | PA10492 |
Legacy codes, insurance codes and state license numbers:
| Issuer | Number | State | Type |
|---|---|---|---|
