Healthcare Provider Details

I. General information

NPI: 1114051588
Provider Name (Legal Business Name): CARLO FERRARONE PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2007
Last Update Date: 12/30/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1110 N DUTTON AVE
SANTA ROSA CA
95401-4606
US

IV. Provider business mailing address

455 OCONNOR DR SUITE 390
SAN JOSE CA
95128-1633
US

V. Phone/Fax

Practice location:
  • Phone: 707-396-5151
  • Fax:
Mailing address:
  • Phone: 408-918-0405
  • Fax: 408-918-0409

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA 17917
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: