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NPI Code Detail

MEDICARE: CAROLYN DELORES BATES

MEDICARE: CAROLYN DELORES BATES
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183700000XPharmacy Technician5733CA
2164X00000XLicensed Vocational Nurse705588CA

General Provider Information

NPI Number : 1144824517
Entity Type Code : Individual
Provider Name (Legal Business Name) : CAROLYN DELORES BATES
Provider Business Mailing Address
First Line : 9124 S WESTERN AVE
Second Line :
City : LOS ANGELES
State : CA
Zip : 90047-3518
Country : US
Telephone Number : 213-325-2348
Fax Number :
Provider Business Practice Location Address
First Line : 9124 S WESTERN AVE
Second Line :
City : LOS ANGELES
State : CA
Zip : 90047-3518
Country : US
Telephone Number : 213-325-2348
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/25/2020
Last Update Date : 11/25/2020

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Directions to “ CAROLYN DELORES BATES ” Practice Location

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