Individual
MAYRA CARBONI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
N.P.
Contact information
Practice address
1415 ROSS AVE, EL CENTRO, CA 92243-4306
(760) 339-7254
(760) 339-4514
Mailing address
686 BAHIA ST, IMPERIAL, CA 92251-8002
(760) 996-1452
Taxonomy
Speciality
Code
Description
License number
State
363LP2300X
Primary Care Nurse Practitioner
Primary
95002659
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
NPF95002659
NP
CA
Enumeration date
07/16/2015
Last updated
02/12/2016
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