Healthcare Provider Details

I. General information

NPI: 1518215375
Provider Name (Legal Business Name): ROCIO VERONICA CARBONA PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/27/2012
Last Update Date: 08/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 PLEASANT ST
OAKLAND ME
04963-5074
US

IV. Provider business mailing address

1138 MAIN ST # 562
READFIELD ME
04355-9998
US

V. Phone/Fax

Practice location:
  • Phone: 207-465-2138
  • Fax: 207-465-4629
Mailing address:
  • Phone: 917-532-0350
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA1351
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: