Provider Demographics
NPI:1992728075
Name:DOYLE, CARLA IWATA (MOTRL CHT)
Entity type:Individual
Prefix:MRS
First Name:CARLA
Middle Name:IWATA
Last Name:DOYLE
Suffix:
Gender:F
Credentials:MOTRL CHT
Other - Prefix:MS
Other - First Name:CARLA
Other - Middle Name:MELINA
Other - Last Name:IWATA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MOTR/L,CHT
Mailing Address - Street 1:14538 LOLLY LN STE C
Mailing Address - Street 2:
Mailing Address - City:SONORA
Mailing Address - State:CA
Mailing Address - Zip Code:95370-8447
Mailing Address - Country:US
Mailing Address - Phone:209-533-1600
Mailing Address - Fax:209-533-1611
Practice Address - Street 1:14538 LOLLY LN STE C
Practice Address - Street 2:
Practice Address - City:SONORA
Practice Address - State:CA
Practice Address - Zip Code:95370-8447
Practice Address - Country:US
Practice Address - Phone:209-533-1600
Practice Address - Fax:209-533-1611
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2017-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT143225X00000X
CA1031100090225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
6710510001Medicare NSC