Healthcare Provider Details

I. General information

NPI: 1578109419
Provider Name (Legal Business Name): CARBON HEALTH MEDICAL GROUP OF CALIFORNIA PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/26/2019
Last Update Date: 06/25/2025
Certification Date: 06/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 E COLORADO BLVD STE 120
PASADENA CA
91101-2006
US

IV. Provider business mailing address

55 PACIFIC AVE
SAN FRANCISCO CA
94111-2009
US

V. Phone/Fax

Practice location:
  • Phone: 323-301-7988
  • Fax: 888-972-1912
Mailing address:
  • Phone: 415-200-2099
  • Fax: 888-972-1912

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MARLEY PAGE
Title or Position: DRECTOR
Credential:
Phone: 417-861-9739