=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699974683
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CAREN ZILBER DO
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/11/2007
-----------------------------------------------------
Last Update Date | 07/11/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3324 CHANATE RD
-----------------------------------------------------
City | SANTA ROSA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95404-1708
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 707-576-4070
-----------------------------------------------------
Fax | 707-576-4087
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 901 RUSSELL AVE APT 244
-----------------------------------------------------
City | SANTA ROSA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95403-2693
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 415-515-1557
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 20A9714
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------