Basic Information
| Provider Information | |||||||||
| NPI: | 1679560197 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GORUM | ||||||||
| FirstName: | CARLA | ||||||||
| MiddleName: | COLLINS | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3400 DATA DR | ||||||||
| Address2: | |||||||||
| City: | RANCHO CORDOVA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 956707956 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9163792915 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1820 41ST AVE | ||||||||
| Address2: | SUITE D | ||||||||
| City: | CAPITOLA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 950102516 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8314763000 | ||||||||
| FaxNumber: | 8314769009 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/29/2005 | ||||||||
| LastUpdateDate: | 11/02/2012 | ||||||||
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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 | 208000000X | A86939 | CA | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.