Healthcare Provider Details

I. General information

NPI: 1902995236
Provider Name (Legal Business Name): CAROLYN DANA CZAPLICKI D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 03/05/2025
Certification Date: 03/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

887 W 9TH ST
SAN PEDRO CA
90731-3603
US

IV. Provider business mailing address

6537 CERTA DR
RANCHO PALOS VERDES CA
90275-3211
US

V. Phone/Fax

Practice location:
  • Phone: 310-547-0887
  • Fax: 310-547-4296
Mailing address:
  • Phone: 310-377-4237
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number20A6605
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: