Healthcare Provider Details

I. General information

NPI: 1316450141
Provider Name (Legal Business Name): ASHLEIGH CARRANZA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2017
Last Update Date: 11/15/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1178 DIXON DR
CHULA VISTA CA
91911-3305
US

IV. Provider business mailing address

1178 DIXON DR
CHULA VISTA CA
91911-3305
US

V. Phone/Fax

Practice location:
  • Phone: 619-948-6909
  • Fax:
Mailing address:
  • Phone: 619-948-6909
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: