Provider Demographics
NPI:1285769562
Name:POWELL, CARL A (DO)
Entity type:Individual
Prefix:DR
First Name:CARL
Middle Name:A
Last Name:POWELL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:519 ROCKPORT CT
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-1537
Mailing Address - Country:US
Mailing Address - Phone:760-436-0830
Mailing Address - Fax:760-633-4246
Practice Address - Street 1:519 ROCKPORT CT
Practice Address - Street 2:
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-1537
Practice Address - Country:US
Practice Address - Phone:760-436-0830
Practice Address - Fax:760-633-4246
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2008-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A5426208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAI21901Medicare UPIN
CA20A5426Medicare PIN