MEDICARE: VIVIAN W CARLTON PA-C

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
1	363A00000X	Physician Assistant	19938	CA

General Provider Information

NPI Number	:	1609029867
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VIVIAN W CARLTON PA-C

Provider Business Mailing Address
First Line	:	6260 EL CAMINO REAL STE 101
Second Line	:
City	:	CARLSBAD
State	:	CA
Zip	:	92009-1609
Country	:	US
Telephone Number	:	760-448-6650
Fax Number	:	760-448-6647

Provider Business Practice Location Address
First Line	:	6260 EL CAMINO REAL STE 101
Second Line	:
City	:	CARLSBAD
State	:	CA
Zip	:	92009-1609
Country	:	US
Telephone Number	:	760-448-6650
Fax Number	:	760-448-6647

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/30/2008
Last Update Date	:	06/22/2025

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