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General NPI Number Information
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NPI Number | 1902091028
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Entity Type | Organization
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Legal Business Name | MICHELE CARPENTER, M.D., INC
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Dates
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Enumeration Date | 09/11/2007
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Last Update Date | 03/10/2016
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Provider Practice Location Address
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Address Line | 1010 W LA VETA AVE SUITE 475
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City | ORANGE
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State | CA
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Zip | 92868-4300
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Country | US
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Telephone | 714-565-0166
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Fax | 714-937-0166
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Provider Business Mailing Address
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Address Line | 1010 W LA VETA AVE SUITE 475
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City | ORANGE
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State | CA
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Zip | 92868-4300
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Country | US
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Telephone | 714-565-0166
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Fax | 714-937-0166
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Authorized Official
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Title or Position | PRESIDENT
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Name | MICHELE M. CARPENTER
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Credential | MD
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Telephone | 714-565-0166
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086X0206X
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Taxonomy Name | Surgical Oncology Physician
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License Number | G58755
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License Number State | CA
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