Healthcare Provider Details

I. General information

NPI: 1801384458
Provider Name (Legal Business Name): ALEXIS EPONINE CARMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2018
Last Update Date: 04/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 DISCOVERY
IRVINE CA
92618-3131
US

IV. Provider business mailing address

1730 ARTHUR DR
BREA CA
92821-1868
US

V. Phone/Fax

Practice location:
  • Phone: 949-203-8877
  • Fax:
Mailing address:
  • Phone: 714-403-7342
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: