Healthcare Provider Details

I. General information

NPI: 1265027775
Provider Name (Legal Business Name): AMY MARIE CARNEY PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/05/2021
Last Update Date: 01/09/2023
Certification Date: 01/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 N TUSTIN AVE
SANTA ANA CA
92705-3502
US

IV. Provider business mailing address

1001 N TUSTIN AVE
SANTA ANA CA
92705-3502
US

V. Phone/Fax

Practice location:
  • Phone: 714-953-3500
  • Fax:
Mailing address:
  • Phone: 714-953-3500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number8658
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number62065
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: