Provider Demographics
NPI:1548355712
Name:KAKUTANI, CARLA J (MD)
Entity type:Individual
Prefix:
First Name:CARLA
Middle Name:J
Last Name:KAKUTANI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:10470 OLD PLACERVILLE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95827-2539
Mailing Address - Country:US
Mailing Address - Phone:855-771-0335
Mailing Address - Fax:
Practice Address - Street 1:111 MAIN ST
Practice Address - Street 2:SUITE B
Practice Address - City:WINTERS
Practice Address - State:CA
Practice Address - Zip Code:95694-1930
Practice Address - Country:US
Practice Address - Phone:530-795-4591
Practice Address - Fax:530-795-0315
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2015-07-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG70090207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
00G700900Medicare ID - Type Unspecified
G34783Medicare UPIN
CA00G700901Medicare PIN
CA00G700900Medicare ID - Type Unspecified