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NPI Code Detail

MEDICARE: CAROLYN ODUCADO PA

MEDICARE: CAROLYN ODUCADO PA
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
1363A00000XPhysician AssistantPA13678CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1PA13678OTHERCALICENSE

General Provider Information

NPI Number : 1194934380
Entity Type Code : Individual
Provider Name (Legal Business Name) : CAROLYN ODUCADO PA
Provider Business Mailing Address
First Line : 17425 BRIARDALE LN
Second Line :
City : YORBA LINDA
State : CA
Zip : 92886-1844
Country : US
Telephone Number : 714-342-8642
Fax Number :
Provider Business Practice Location Address
First Line : 1695 N SUNRISE WAY
Second Line :
City : PALM SPRINGS
State : CA
Zip : 92262-3701
Country : US
Telephone Number : 760-323-2118
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/22/2007
Last Update Date : 01/05/2026

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Directions to “ CAROLYN ODUCADO PA” Practice Location

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