Healthcare Provider Details

I. General information

NPI: 1093626848
Provider Name (Legal Business Name): NALLELY YASEL CARVAJAL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/12/2026
Last Update Date: 09/12/2026
Certification Date: 09/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

480 TRESHILL RD APT 274
IMPERIAL CA
92251-9813
US

IV. Provider business mailing address

480 TRESHILL RD APT 274
IMPERIAL CA
92251-9813
US

V. Phone/Fax

Practice location:
  • Phone: 760-540-8413
  • Fax:
Mailing address:
  • Phone: 760-540-8413
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number95388866
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: