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General NPI Number Information
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NPI Number | 1164628475
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Entity Type | Individual
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Provider Name | CARLA DIANE STEWART FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 06/23/2007
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Last Update Date | 12/12/2008
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Provider Practice Location Address
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Address Line | 25837 OAK ST #228
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City | LOMITA
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State | CA
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Zip | 90717-3156
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Country | US
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Telephone | 310-962-9813
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Fax |
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Provider Business Mailing Address
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Address Line | 25837 OAK ST #228
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City | LOMITA
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State | CA
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Zip | 90717-3156
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Country | US
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Telephone | 310-962-9813
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 504098
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 9972
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License Number State | CA
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