Healthcare Provider Details

I. General information

NPI: 1255957205
Provider Name (Legal Business Name): CARBON HEALTH MEDICAL GROUP OF CALIFORNIA PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2020
Last Update Date: 06/25/2025
Certification Date: 06/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

55 PACIFIC AVE # 101
SAN FRANCISCO CA
94111-2009
US

V. Phone/Fax

Practice location:
  • Phone: 415-200-2133
  • Fax:
Mailing address:
  • Phone: 415-200-2133
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

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