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General NPI Number Information
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NPI Number | 1114175171
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Entity Type | Individual
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Provider Name | CARLA A URSETTA O.D.
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Gender | Female
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Dates
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Enumeration Date | 09/03/2008
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Last Update Date | 09/05/2018
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Provider Practice Location Address
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Address Line | 27270 ALICIA PKWY SUITE
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City | LAGUNA NIGUEL
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State | CA
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Zip | 92677
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Country | US
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Telephone | 630-841-6549
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Fax |
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Provider Business Mailing Address
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Address Line | 7407 MELROSE AVE
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City | LOS ANGELES
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State | CA
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Zip | 90046-7514
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Country | US
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Telephone | 323-653-8176
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 046010096
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 33344
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License Number State | CA
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