Provider Demographics
NPI:1427100866
Name:CARMEL I. ERNEST, M.D., INC.
Entity type:Organization
Organization Name:CARMEL I. ERNEST, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CARMEL
Authorized Official - Middle Name:I
Authorized Official - Last Name:ERNEST
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:661-949-7615
Mailing Address - Street 1:1672 W AVENUE J
Mailing Address - Street 2:SUITE 103
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93534-2827
Mailing Address - Country:US
Mailing Address - Phone:661-949-7615
Mailing Address - Fax:661-949-7679
Practice Address - Street 1:1672 W AVENUE J
Practice Address - Street 2:SUITE 103
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-2827
Practice Address - Country:US
Practice Address - Phone:661-949-7615
Practice Address - Fax:661-949-7679
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA42995207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A429950Medicaid
CAA42995Medicare ID - Type Unspecified