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NPI Code Detail

MEDICARE: KAYLENE R CARR M.D.

MEDICARE: KAYLENE R CARR M.D.
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
1174400000XSpecialistA124094CA
2207V00000XObstetrics & Gynecology PhysicianA124094CA

General Provider Information

NPI Number : 1497046361
Entity Type Code : Individual
Provider Name (Legal Business Name) : KAYLENE R CARR M.D.
Provider Business Mailing Address
First Line : 6767 BROCKTON AVE
Second Line :
City : RIVERSIDE
State : CA
Zip : 92506-3023
Country : US
Telephone Number : 951-823-0441
Fax Number : 951-823-0447
Provider Business Practice Location Address
First Line : 1800 N. WESTERN AVE STE 204
Second Line :
City : SAN BERNARDINO
State : CA
Zip : 92411-1353
Country : US
Telephone Number : 909-474-9952
Fax Number : 909-474-9951
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/27/2011
Last Update Date : 04/16/2019

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Directions to “ KAYLENE R CARR M.D.” Practice Location

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