Provider Demographics
NPI:1326781238
Name:LADWIG-COX, CARISSA (PA-C)
Entity type:Individual
Prefix:
First Name:CARISSA
Middle Name:
Last Name:LADWIG-COX
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7150 WESTPORT ST
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92506-6107
Mailing Address - Country:US
Mailing Address - Phone:818-770-8151
Mailing Address - Fax:
Practice Address - Street 1:1230 E ARROW HWY
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-4910
Practice Address - Country:US
Practice Address - Phone:909-622-1235
Practice Address - Fax:909-948-0506
Is Sole Proprietor?:No
Enumeration Date:2022-04-18
Last Update Date:2025-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA60828363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant