Healthcare Provider Details

I. General information

NPI: 1932276227
Provider Name (Legal Business Name): TODD A CARRELL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

532 OREGON ST
VALLEJO CA
94590-3254
US

IV. Provider business mailing address

532 OREGON ST
VALLEJO CA
94590-3254
US

V. Phone/Fax

Practice location:
  • Phone: 707-649-4007
  • Fax: 707-649-4077
Mailing address:
  • Phone: 707-649-4007
  • Fax: 707-649-4077

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA50250
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: