Basic Information
| Provider Information | |||||||||
| NPI: | 1598841561 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CARRIER | ||||||||
| FirstName: | EWA | ||||||||
| MiddleName: | K | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3855 HEALTH SCIENCES DRIVE # 0960 | ||||||||
| Address2: | |||||||||
| City: | LA JOLLA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920930960 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8588226600 | ||||||||
| FaxNumber: | 8588221111 | ||||||||
| Practice Location | |||||||||
| Address1: | 3855 HEALTH SCIENCES DRIVE #0960 | ||||||||
| Address2: | |||||||||
| City: | LA JOLLA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920930960 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8588226600 | ||||||||
| FaxNumber: | 8588221111 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/31/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RH0003X | A47844 | CA | X | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology | 2080P0207X | A47844 | CA | X | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Hematology-Oncology |
ID Information
| ID | Type | State | Issuer | Description | 00A478440 | 05 | CA | MEDICAID |