Healthcare Provider Details

I. General information

NPI: 1639085087
Provider Name (Legal Business Name): CARIE KAY TOL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

270 W 14TH ST
SAN PEDRO CA
90731-4396
US

IV. Provider business mailing address

2320 STEARNLEE AVE
LONG BEACH CA
90815-1935
US

V. Phone/Fax

Practice location:
  • Phone: 310-519-8723
  • Fax:
Mailing address:
  • Phone: 562-552-8009
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number716748
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: