Healthcare Provider Details

I. General information

NPI: 1902091028
Provider Name (Legal Business Name): MICHELE CARPENTER, M.D., INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2007
Last Update Date: 03/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 W LA VETA AVE SUITE 475
ORANGE CA
92868-4300
US

IV. Provider business mailing address

1010 W LA VETA AVE SUITE 475
ORANGE CA
92868-4300
US

V. Phone/Fax

Practice location:
  • Phone: 714-565-0166
  • Fax: 714-937-0166
Mailing address:
  • Phone: 714-565-0166
  • Fax: 714-937-0166

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License NumberG58755
License Number StateCA

VIII. Authorized Official

Name: MICHELE M. CARPENTER
Title or Position: PRESIDENT
Credential: MD
Phone: 714-565-0166