MEDICARE: PRISCILLA TORRALBA CARBONELL

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	310400000X	Assisted Living Facility	340309927	CA

General Provider Information

NPI Number	:	1699049155
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PRISCILLA TORRALBA CARBONELL

Provider Business Mailing Address
First Line	:	1890 PEBBLEWOOD DR
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95833-2660
Country	:	US
Telephone Number	:	916-920-8479
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 TIMBERWOOD CT
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95833-1805
Country	:	US
Telephone Number	:	916-996-8834
Fax Number	:

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

Provider Enumeration Date	:	03/01/2012
Last Update Date	:	03/01/2012

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