Healthcare Provider Details

I. General information

NPI: 1891706594
Provider Name (Legal Business Name): CAROLYN C COMILANG M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

1170 W OLIVE AVE SUITE I
MERCED CA
95348-1959
US

IV. Provider business mailing address

1170 W OLIVE AVE SUITE I
MERCED CA
95348-1959
US

V. Phone/Fax

Practice location:
  • Phone: 209-722-2784
  • Fax: 209-722-2452
Mailing address:
  • Phone: 209-722-2784
  • Fax: 209-722-2452

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA44332
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: