Basic Information
| Provider Information | |||||||||
| NPI: | 1306588173 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RESNER | ||||||||
| FirstName: | CAROLYN | ||||||||
| MiddleName: | MARIE | ||||||||
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| Credential: | PHD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5875 ETTERSBERG DR | ||||||||
| Address2: | |||||||||
| City: | SAN JOSE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 951233514 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7083415106 | ||||||||
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| Practice Location | |||||||||
| Address1: | 31625 HIGHWAY 101 S | ||||||||
| Address2: | |||||||||
| City: | SOLEDAD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 939609529 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8316785500 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/11/2022 | ||||||||
| LastUpdateDate: | 04/11/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/11/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.