=====================================================
General NPI Number Information
=====================================================
NPI Number | 1144779851
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CONSUELO CARRASCO
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/23/2016
-----------------------------------------------------
Last Update Date | 09/23/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 490 NORTH GRAPE STREET ESPERANZA CRISIS CENTER
-----------------------------------------------------
City | ESCONDIDO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92025
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-975-9939
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 31289 HURON ST
-----------------------------------------------------
City | TEMECULA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92592-5704
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-412-0802
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 164X00000X
-----------------------------------------------------
Taxonomy Name | Licensed Vocational Nurse
-----------------------------------------------------
License Number | VN269905
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------