Basic Information
| Provider Information | |||||||||
| NPI: | 1194083477 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CARLSON | ||||||||
| FirstName: | NATALIYA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1066 S WHITE RD STE 170 | ||||||||
| Address2: | |||||||||
| City: | SAN JOSE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 951273812 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4087299700 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1066 S WHITE RD STE 170 | ||||||||
| Address2: | |||||||||
| City: | SAN JOSE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 951273812 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4087299700 | ||||||||
| FaxNumber: | 9169201430 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/24/2012 | ||||||||
| LastUpdateDate: | 04/13/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/13/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | A130050 | CA | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207V00000X | A130050 | CA | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
No ID Information.