Provider Demographics
NPI:1902091028
Name:MICHELE CARPENTER, M.D., INC
Entity Type:Organization
Organization Name:MICHELE CARPENTER, M.D., INC
Other - Org Name:ORANGE COUNTY BREAST CARE SPECIALISTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:M
Authorized Official - Last Name:CARPENTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-565-0166
Mailing Address - Street 1:1010 W LA VETA AVE
Mailing Address - Street 2:SUITE 475
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-4300
Mailing Address - Country:US
Mailing Address - Phone:714-565-0166
Mailing Address - Fax:714-937-0166
Practice Address - Street 1:1010 W LA VETA AVE
Practice Address - Street 2:SUITE 475
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-4300
Practice Address - Country:US
Practice Address - Phone:714-565-0166
Practice Address - Fax:714-937-0166
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-11
Last Update Date:2016-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG587552086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G587550Medicaid
CAW21272OtherMEDICARE GROUP PIN
CAWG58755NMedicare PIN