MEDICARE: MS. IDA CARLSON

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	101YM0800X	Mental Health Counselor
2	172V00000X	Community Health Worker
3	225400000X	Rehabilitation Practitioner

General Provider Information

NPI Number	:	1407920663
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. IDA CARLSON

Provider Business Mailing Address
First Line	:	3601 CALLE TECATE STE 201
Second Line	:
City	:	CAMARILLO
State	:	CA
Zip	:	93012-5056
Country	:	US
Telephone Number	:	805-798-6574
Fax Number	:

Provider Business Practice Location Address
First Line	:	3601 CALLE TECATE STE 201
Second Line	:
City	:	CAMARILLO
State	:	CA
Zip	:	93012-5056
Country	:	US
Telephone Number	:	805-794-6574
Fax Number	:

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

Provider Enumeration Date	:	11/20/2006
Last Update Date	:	07/21/2025

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Directions to “ MS. IDA CARLSON ” Practice Location

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