Provider Demographics
NPI:1699049155
Name:CARBONELL, PRISCILLA TORRALBA
Entity type:Individual
Prefix:
First Name:PRISCILLA
Middle Name:TORRALBA
Last Name:CARBONELL
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 1:1890 PEBBLEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95833-2660
Mailing Address - Country:US
Mailing Address - Phone:916-920-8479
Mailing Address - Fax:
Practice Address - Street 1:1 TIMBERWOOD CT
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95833-1805
Practice Address - Country:US
Practice Address - Phone:916-996-8834
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-01
Last Update Date:2012-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA340309927310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility