Provider Demographics
NPI:1144824517
Name:BATES, CAROLYN DELORES
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:DELORES
Last Name:BATES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9124 S WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90047-3518
Mailing Address - Country:US
Mailing Address - Phone:213-325-2348
Mailing Address - Fax:
Practice Address - Street 1:9124 S WESTERN AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90047-3518
Practice Address - Country:US
Practice Address - Phone:213-325-2348
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-25
Last Update Date:2020-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5733183700000X
CA705588164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse
No183700000XPharmacy Service ProvidersPharmacy Technician