Provider Demographics
NPI:1215987540
Name:PELINO CARROLL, MARY ANN (MD)
Entity type:Individual
Prefix:DR
First Name:MARY ANN
Middle Name:
Last Name:PELINO CARROLL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MARYANN
Other - Middle Name:
Other - Last Name:PELINO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:6650 ALTON PARKWAY, 3RD FLOOR
Mailing Address - Street 2:KAISER PERMANENTE ORANGE COUNTY OBSTETRICS & GYNECOLOGY
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6650 ALTON PARKWAY, MOB2 3RD FLOOR
Practice Address - Street 2:KAISER PERMANENTE OBSTETRICS & GYNECOLOGY
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618
Practice Address - Country:US
Practice Address - Phone:949-932-5655
Practice Address - Fax:949-932-6348
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA76094174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABP75599808OtherDEA NUMBER