Healthcare Provider Details

I. General information

NPI: 1891883286
Provider Name (Legal Business Name): CAROLE MACAULAY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 W LA HABRA BLVD STE 5
LA HABRA CA
90631-4354
US

IV. Provider business mailing address

2501 W LA HABRA BLVD STE 5
LA HABRA CA
90631-4354
US

V. Phone/Fax

Practice location:
  • Phone: 562-690-9444
  • Fax: 562-690-9404
Mailing address:
  • Phone: 562-690-9444
  • Fax: 562-690-9404

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberG66162
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: