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NPI Code Detail

MEDICARE: CARRIE LO

MEDICARE: CARRIE LO
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
1208000000XPediatrics PhysicianMD61586753WA

General Provider Information

NPI Number : 1942761903
Entity Type Code : Individual
Provider Name (Legal Business Name) : CARRIE LO
Provider Business Mailing Address
First Line : 25233 132ND PL SE
Second Line :
City : KENT
State : WA
Zip : 98042-6615
Country : US
Telephone Number : 253-293-0213
Fax Number :
Provider Business Practice Location Address
First Line : 747 52ND ST
Second Line :
City : OAKLAND
State : CA
Zip : 94609-1809
Country : US
Telephone Number : 510-428-3331
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/30/2019
Last Update Date : 03/09/2026

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Directions to “ CARRIE LO ” Practice Location

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