Healthcare Provider Details

I. General information

NPI: 1326321399
Provider Name (Legal Business Name): VERNELL CARROLL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2011
Last Update Date: 09/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1609 E PALMDALE BLVD SUITE G
PALMDALE CA
93550-4881
US

IV. Provider business mailing address

1609 E PALMDALE SUITE G
PALMDALE CA
93550-4881
US

V. Phone/Fax

Practice location:
  • Phone: 661-947-1595
  • Fax: 661-272-0415
Mailing address:
  • Phone: 805-886-5660
  • Fax: 661-272-0415

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: