Healthcare Provider Details

I. General information

NPI: 1114149275
Provider Name (Legal Business Name): KRISTINA DEPAOLO CARLIN D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 12/15/2020
Certification Date: 12/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6707 POWERS BLVD SUITE 203
PARMA OH
44129-5455
US

IV. Provider business mailing address

6707 POWERS BLVD SUITE 203
PARMA OH
44129-5455
US

V. Phone/Fax

Practice location:
  • Phone: 440-845-1500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number34.010846
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: