Healthcare Provider Details

I. General information

NPI: 1770543712
Provider Name (Legal Business Name): MICHELE M. CARPENTER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2006
Last Update Date: 04/22/2025
Certification Date: 04/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 W LA VETA AVE SUITE 470
ORANGE CA
92868
US

IV. Provider business mailing address

1000 W LAVETA AVE
ORANGE CA
92868-4305
US

V. Phone/Fax

Practice location:
  • Phone: 714-565-0166
  • Fax: 714-937-0166
Mailing address:
  • Phone: 714-734-6216
  • Fax: 888-424-9767

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License NumberG58755
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberG58755
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: