Healthcare Provider Details

I. General information

NPI: 1891088100
Provider Name (Legal Business Name): CARLA DYKES MA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2011
Last Update Date: 10/17/2024
Certification Date: 10/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25170 HANCOCK AVE STE 250
MURRIETA CA
92562-5969
US

IV. Provider business mailing address

PO BOX 460874
ESCONDIDO CA
92046-0874
US

V. Phone/Fax

Practice location:
  • Phone: 858-966-8300
  • Fax:
Mailing address:
  • Phone: 951-297-7807
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberIMF 71798
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number95935
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: