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General NPI Number Information
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NPI Number | 1447020375
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Entity Type | Individual
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Provider Name | BEVERLY CARBONE
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Gender | Female
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Dates
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Enumeration Date | 01/02/2024
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Last Update Date | 01/22/2024
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Provider Practice Location Address
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Address Line | 18546 ROSCOE BLVD
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City | NORTHRIDGE
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State | CA
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Zip | 91324-4663
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Country | US
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Telephone | 818-885-8355
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Fax |
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Provider Business Mailing Address
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Address Line | 11257 N ADOBE LN
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City | MISSION HILLS
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State | CA
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Zip | 91345-1420
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Country | US
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Telephone | 805-304-7332
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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 | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | 95026158
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License Number State | CA
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