Basic Information
| Provider Information | |||||||||
| NPI: | 1467714519 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CAROLINA | ||||||||
| FirstName: | DAMEELAH | ||||||||
| MiddleName: | ROSE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1530 S OLIVE ST | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900153023 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2137475542 | ||||||||
| FaxNumber: | 2137469379 | ||||||||
| Practice Location | |||||||||
| Address1: | 1530 S OLIVE ST | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900153023 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2137475542 | ||||||||
| FaxNumber: | 2137469379 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/14/2012 | ||||||||
| LastUpdateDate: | 12/15/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367A00000X | Y | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife |
No ID Information.