Provan, Carol Joy

Provan, Carol Joy is an individual health care provider with primary practice located at 2710 Middlefield Rd , Redwood City CA 94063-3404. She recently has only one registered license in Allopathic & Osteopathic Physicians / Pediatrics, which is considered as her primary health care specialty. Provan, Carol Joy can be contacted via phone (650) 573-2222.

Contact Information

Primary practice address
2710 Middlefield Rd Redwood City CA 94063-3404
Phone: (650) 573-2222
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Pediatrics 208000000X A25599 California

Profile Details

NPI number 1780736041
LBN Legal business name Provan, Carol Joy
Credentials
Entity Individual
Sole proprietor 1 No
Enumeration date Jan 17th, 2007
Last updated Jul 8th, 2007 - about 17 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1780736041 NPPES
California MEDICAID 00A255990

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