Provider Demographics
NPI:1427517978
Name:CARRION, CARLA ELENA
Entity type:Individual
Prefix:
First Name:CARLA
Middle Name:ELENA
Last Name:CARRION
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 1:1754 W. RICHLAND
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92703
Mailing Address - Country:US
Mailing Address - Phone:714-884-2008
Mailing Address - Fax:
Practice Address - Street 1:1754 RICHLAND AVE
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92703-4627
Practice Address - Country:US
Practice Address - Phone:714-884-2008
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-14
Last Update Date:2019-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA99354810DMedicaid