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NPI Code Detail

MEDICARE: DR. CAROL VICTOR CARLSON DOCTORATE - PHD

MEDICARE: DR. CAROL VICTOR CARLSON DOCTORATE - PHD
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
1103TC0700XClinical PsychologistPSY14518CA
2103T00000XPsychologistPSY14518CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
10PL145180OTHERCABLUE SHIELD PROVIDER #

General Provider Information

NPI Number : 1710102595
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. CAROL VICTOR CARLSON DOCTORATE - PHD
Provider Business Mailing Address
First Line : 405 ROCKEFELLER UNIT 906
Second Line :
City : IRVINE
State : CA
Zip : 92612-7192
Country : US
Telephone Number : 510-444-1110
Fax Number : 949-885-8885
Provider Business Practice Location Address
First Line : 4199 CAMPUS DR STE 550
Second Line :
City : IRVINE
State : CA
Zip : 92612-4694
Country : US
Telephone Number : 510-444-1110
Fax Number : 949-885-8885
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/16/2007
Last Update Date : 06/05/2024

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