Healthcare Provider Details

I. General information

NPI: 1619767647
Provider Name (Legal Business Name): CAROL ANNE STATE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2025
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13210 FLORENCE AVE
SANTA FE SPRINGS CA
90670-4510
US

IV. Provider business mailing address

1903 N LINDENHOLZ ST
ORANGE CA
92865-4535
US

V. Phone/Fax

Practice location:
  • Phone: 562-574-2637
  • Fax: 213-533-1066
Mailing address:
  • Phone: 562-574-2637
  • Fax: 213-533-1066

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: