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NPI Code Detail

MEDICARE: MS. IDA CARLSON

MEDICARE: MS. IDA CARLSON
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
1101YM0800XMental Health Counselor
2172V00000XCommunity Health Worker
3225400000XRehabilitation Practitioner

General Provider Information

NPI Number : 1407920663
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. IDA CARLSON
Provider Business Mailing Address
First Line : 3601 CALLE TECATE STE 201
Second Line :
City : CAMARILLO
State : CA
Zip : 93012-5056
Country : US
Telephone Number : 805-798-6574
Fax Number :
Provider Business Practice Location Address
First Line : 3601 CALLE TECATE STE 201
Second Line :
City : CAMARILLO
State : CA
Zip : 93012-5056
Country : US
Telephone Number : 805-794-6574
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/20/2006
Last Update Date : 07/21/2025

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