Healthcare Provider Details

I. General information

NPI: 1316698715
Provider Name (Legal Business Name): CARLYSLE CABIO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/17/2022
Last Update Date: 04/03/2023
Certification Date: 04/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 OCEANGATE STE 100
LONG BEACH CA
90802-4317
US

IV. Provider business mailing address

7011 EL DORADO DR APT B
BUENA PARK CA
90620-2443
US

V. Phone/Fax

Practice location:
  • Phone: 888-562-5442
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WH1000X
TaxonomyHospice Registered Nurse
License Number95119927
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95023635
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95023635
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: