Healthcare Provider Details

I. General information

NPI: 1063134963
Provider Name (Legal Business Name): THOMAS CARRESE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2022
Last Update Date: 09/16/2022
Certification Date: 09/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

268 VILLAGE COMMONS BLVD
CAMARILLO CA
93012-6826
US

IV. Provider business mailing address

150 S 5TH ST STE 2300
MINNEAPOLIS MN
55402-4223
US

V. Phone/Fax

Practice location:
  • Phone: 805-437-6675
  • Fax:
Mailing address:
  • Phone: 763-268-4286
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: