Healthcare Provider Details

I. General information

NPI: 1972594893
Provider Name (Legal Business Name): LYDIA CARPENTER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2005
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23501 CINEMA DR STE 111
VALENCIA CA
91355-5429
US

IV. Provider business mailing address

23501 CINEMA DR STE 111
VALENCIA CA
91355-5429
US

V. Phone/Fax

Practice location:
  • Phone: 661-258-3811
  • Fax: 661-382-8343
Mailing address:
  • Phone: 661-258-3811
  • Fax: 661-382-8343

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberA84038
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: