Healthcare Provider Details

I. General information

NPI: 1548673692
Provider Name (Legal Business Name): TAYLOR ROSE CARLE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TAYLOR ROSE MANTON

II. Dates (important events)

Enumeration Date: 06/06/2014
Last Update Date: 07/06/2022
Certification Date: 07/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 S RAYMOND AVE UNIT 201
PASADENA CA
91105-3283
US

IV. Provider business mailing address

630 S RAYMOND AVE UNIT 201
PASADENA CA
91105-3283
US

V. Phone/Fax

Practice location:
  • Phone: 424-314-0196
  • Fax:
Mailing address:
  • Phone: 424-314-0196
  • Fax: 424-314-0199

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberA161283
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: