Healthcare Provider Details

I. General information

NPI: 1700894540
Provider Name (Legal Business Name): MARY ANN CAROL CARLOS BESANA I MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MARY ANN CAROL CARLOS BESANA M.D.

II. Dates (important events)

Enumeration Date: 08/04/2006
Last Update Date: 01/24/2022
Certification Date: 01/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3285 CLAREMONT WAY MEDICINE 3
NAPA CA
94558-3313
US

IV. Provider business mailing address

3285 CLAREMONT WAY
NAPA CA
94558-3313
US

V. Phone/Fax

Practice location:
  • Phone: 707-258-2166
  • Fax:
Mailing address:
  • Phone: 707-258-2166
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number230393
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: