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General NPI Number Information
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NPI Number | 1578023917
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Entity Type | Individual
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Provider Name | PETER PAUL CARREON FNP
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Gender | Male
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Dates
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Enumeration Date | 03/21/2019
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Last Update Date | 03/21/2019
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Provider Practice Location Address
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Address Line | 13540 SAN ANTONIO AVE
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City | CHINO
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State | CA
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Zip | 91710-7380
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Country | US
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Telephone | 909-573-6294
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Fax |
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Provider Business Mailing Address
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Address Line | 13540 SAN ANTONIO AVE
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City | CHINO
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State | CA
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Zip | 91710-7380
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Country | US
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Telephone |
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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 | 163WC1500X
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Taxonomy Name | Community Health Registered Nurse
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License Number | 544459
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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 | 95010589
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License Number State | CA
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