Healthcare Provider Details

I. General information

NPI: 1265089643
Provider Name (Legal Business Name): CARLA MICHAEL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/21/2019
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date: 08/21/2019
Reactivation Date: 12/05/2023

III. Provider practice location address

2063 RANCHO VALLEY DR
POMONA CA
91766-7107
US

IV. Provider business mailing address

2063 RANCHO VALLEY DR STE 329
POMONA CA
91766-7107
US

V. Phone/Fax

Practice location:
  • Phone: 99-991-9839
  • Fax:
Mailing address:
  • Phone: 909-480-1998
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number783
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: