Healthcare Provider Details

I. General information

NPI: 1487031654
Provider Name (Legal Business Name): CAROLINE BAGSHAW DVM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CARRIE BAGSHAW DVM

II. Dates (important events)

Enumeration Date: 04/27/2015
Last Update Date: 05/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6455 SANTA MONICA BLVD
LOS ANGELES CA
90038-2910
US

IV. Provider business mailing address

6455 SANTA MONICA BLVD
LOS ANGELES CA
90038-2910
US

V. Phone/Fax

Practice location:
  • Phone: 323-919-6666
  • Fax: 323-672-8488
Mailing address:
  • Phone: 323-919-6666
  • Fax: 323-672-8488

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174M00000X
TaxonomyVeterinarian
License Number17638
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: