Provider Demographics
NPI:1316131451
Name:CARMICHAEL, NATALYA
Entity type:Individual
Prefix:DR
First Name:NATALYA
Middle Name:
Last Name:CARMICHAEL
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 1:6841 FISK AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92122-2436
Mailing Address - Country:US
Mailing Address - Phone:323-893-0803
Mailing Address - Fax:
Practice Address - Street 1:9728 CARMEL MOUNTAIN RD STE B
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92129-2849
Practice Address - Country:US
Practice Address - Phone:858-484-2460
Practice Address - Fax:858-484-2597
Is Sole Proprietor?:No
Enumeration Date:2007-08-31
Last Update Date:2019-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA56149122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist