Healthcare Provider Details

I. General information

NPI: 1063186989
Provider Name (Legal Business Name): ISABEL G CARLOS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2021
Last Update Date: 08/04/2021
Certification Date: 07/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39000 BOB HOPE DRIVE PROBST 100B
RANCHO MIRAGE CA
92270
US

IV. Provider business mailing address

39000 BOB HOPE DRIVE PROBST 100B
RANCHO MIRAGE CA
92270
US

V. Phone/Fax

Practice location:
  • Phone: 760-773-1403
  • Fax:
Mailing address:
  • Phone: 760-773-1403
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: