Provider Demographics
NPI:1306693197
Name:CARLES, MAYRA A
Entity type:Individual
Prefix:
First Name:MAYRA
Middle Name:A
Last Name:CARLES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13THADC, 1ST DENTAL BATTALION
Mailing Address - Street 2:BLDG. 13128 14THSTREET
Mailing Address - City:CAMP PENDLETON
Mailing Address - State:CA
Mailing Address - Zip Code:92055-5221
Mailing Address - Country:US
Mailing Address - Phone:619-532-6250
Mailing Address - Fax:
Practice Address - Street 1:13THADC, 1ST DENTAL BATTALION
Practice Address - Street 2:BLDG. 13128 14THSTREET
Practice Address - City:CAMP PENDLETON
Practice Address - State:CA
Practice Address - Zip Code:92055-5221
Practice Address - Country:US
Practice Address - Phone:619-532-6250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-01
Last Update Date:2024-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program