Provider Demographics
NPI:1215055629
Name:CARSON, MIA ELIZABETH (MD)
Entity type:Individual
Prefix:DR
First Name:MIA
Middle Name:ELIZABETH
Last Name:CARSON
Suffix:
Gender:
Credentials:MD
Other - Prefix:DR
Other - First Name:MIA
Other - Middle Name:ELIZABETH
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1545 W FLORIDA AVE
Mailing Address - Street 2:
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92543-3814
Mailing Address - Country:US
Mailing Address - Phone:951-791-1111
Mailing Address - Fax:888-856-3893
Practice Address - Street 1:949 CALHOUN PL STE G
Practice Address - Street 2:
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92543-4403
Practice Address - Country:US
Practice Address - Phone:951-765-5594
Practice Address - Fax:888-662-4491
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC168608207Q00000X
IN01079859A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300012143Medicaid