Healthcare Provider Details

I. General information

NPI: 1013467950
Provider Name (Legal Business Name): KRYSTINA CARCONE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2016
Last Update Date: 09/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31720 TEMECULA PKWY
TEMECULA CA
92592-5802
US

IV. Provider business mailing address

31720 TEMECULA PKWY
TEMECULA CA
92592-5802
US

V. Phone/Fax

Practice location:
  • Phone: 951-303-6900
  • Fax:
Mailing address:
  • Phone: 951-303-6900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number54273
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: