Provider Demographics
NPI:1548914732
Name:FARIAS, CAROLINA YAMIL (CNM)
Entity type:Individual
Prefix:
First Name:CAROLINA
Middle Name:YAMIL
Last Name:FARIAS
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1315 S COCHRAN AVE APT 102
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90019-2707
Mailing Address - Country:US
Mailing Address - Phone:323-401-9630
Mailing Address - Fax:
Practice Address - Street 1:1224 E WARDLOW RD
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90807-4833
Practice Address - Country:US
Practice Address - Phone:562-912-4421
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-07
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA236241367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife