MEDICARE: MRS. ALISSA ANN CARNELIAN MS

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	2084N0600X	Clinical Neurophysiology Physician	AU2270	CA
2	231H00000X	Audiologist	AU2270	CA

General Provider Information

NPI Number	:	1942386859
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ALISSA ANN CARNELIAN MS

Provider Business Mailing Address
First Line	:	4227 MARYLAND ST APT 7
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92103-2346
Country	:	US
Telephone Number	:	520-955-0016
Fax Number	:	877-240-8624

Provider Business Practice Location Address
First Line	:	4227 MARYLAND ST APT 7
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92103-2346
Country	:	US
Telephone Number	:	520-955-0016
Fax Number	:	877-240-8624

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

Provider Enumeration Date	:	10/31/2006
Last Update Date	:	09/23/2014

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