MEDICARE: MS. PAULA ELAINE CARMONA RN, MSN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	364SP0808X	Psychiatric/Mental Health Clinical Nurse Specialist	406733	CA
2	364SP0809X	Adult Psychiatric/Mental Health Clinical Nurse Specialist	406733	CA

General Provider Information

NPI Number	:	1093721003
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. PAULA ELAINE CARMONA RN, MSN

Provider Business Mailing Address
First Line	:	5202 COBB PL
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92117-1228
Country	:	US
Telephone Number	:	858-272-0944
Fax Number	:

Provider Business Practice Location Address
First Line	:	5202 COBB PL
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92117-1228
Country	:	US
Telephone Number	:	858-272-0944
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/31/2006
Last Update Date	:	09/11/2025

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