Provider Demographics
NPI:1386131340
Name:CARLISLE, SYLVIA GATES (MD)
Entity type:Individual
Prefix:
First Name:SYLVIA
Middle Name:GATES
Last Name:CARLISLE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5647 W 64TH ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90056-2235
Mailing Address - Country:US
Mailing Address - Phone:916-704-6427
Mailing Address - Fax:916-756-0202
Practice Address - Street 1:4859 W SLAUSON AVE STE 213
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90056-3208
Practice Address - Country:US
Practice Address - Phone:323-628-6500
Practice Address - Fax:916-756-0202
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-16
Last Update Date:2018-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG50523207R00000X, 207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine