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General NPI Number Information
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NPI Number | 1760594733
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Entity Type | Individual
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Provider Name | CARLETTE SPENGLER KOLESNIK P.A.-C.
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Gender | Female
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 12/22/2021
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Provider Practice Location Address
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Address Line | 9961 SIERRA AVE
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City | FONTANA
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State | CA
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Zip | 92335-6720
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Country | US
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Telephone | 909-427-5402
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Fax |
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Provider Business Mailing Address
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Address Line | 2468 SAN ANTONIO CRES E
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City | UPLAND
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State | CA
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Zip | 91784-1180
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Country | US
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Telephone | 909-946-8737
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Fax | 909-982-1776
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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 | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | PA10850
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License Number State | CA
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