Healthcare Provider Details

I. General information

NPI: 1013615186
Provider Name (Legal Business Name): SHALONTE ALLEN-CARRASQUILLO FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2023
Last Update Date: 10/04/2024
Certification Date: 10/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43322 GINGHAM AVE
LANCASTER CA
93535-4576
US

IV. Provider business mailing address

9001 STOCKDALE HWY
BAKERSFIELD CA
93311-1022
US

V. Phone/Fax

Practice location:
  • Phone: 661-874-4050
  • Fax:
Mailing address:
  • Phone: 661-654-2505
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95030375
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: