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General NPI Number Information
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NPI Number | 1851509244
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Entity Type | Individual
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Provider Name | CAROL VANPETTEN M.D.
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Gender | Female
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Dates
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Enumeration Date | 05/18/2007
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Last Update Date | 12/07/2021
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Provider Practice Location Address
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Address Line | DEPT NEUROLOGY KAISER PERMANENTE 10800 MAGNOLIA AVE
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City | RIVERSIDE
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State | CA
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Zip | 92505
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Country | US
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Telephone | 951-353-4746
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Fax |
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Provider Business Mailing Address
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Address Line | DEPT. NEUROLOGY 10800 MAGNOLIA AVE
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City | RIVERSIDE
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State | CA
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Zip | 92505
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Country | US
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Telephone | 951-353-4746
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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 | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | GO59609
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License Number State | CA
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