=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386611242
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | HERMAN A CARSTENS M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/28/2006
-----------------------------------------------------
Last Update Date | 10/28/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 18601 VALLEY BLVD
-----------------------------------------------------
City | BLOOMINGTON
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92316-1831
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 909-546-7560
-----------------------------------------------------
Fax | 909-546-1091
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 21801 ALESSANDRO BLVD
-----------------------------------------------------
City | MORENO VALLEY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92553-8202
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 951-571-2300
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207V00000X
-----------------------------------------------------
Taxonomy Name | Obstetrics & Gynecology Physician
-----------------------------------------------------
License Number | A34747
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------