Individual
CHARLES ROCK CARLSON JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
1660 E ROSEVILLE PKWY STE 100, ROSEVILLE, CA 95661-3988
(916) 973-5300
Mailing address
1660 E ROSEVILLE PKWY STE 100, ROSEVILLE, CA 95661-3988
(916) 973-5300
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
20A20898
CA
2084P0800X
Psychiatry Physician
34.013717
OH
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0235202
—
OH
Enumeration date
04/11/2017
Last updated
02/13/2024
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