Individual
LACEY MAY CARPENTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.C.
Contact information
Practice address
17742 BEACH BLVD STE 240, HUNTINGTON BEACH, CA 92647-6835
(714) 842-0444
(714) 842-8444
Mailing address
17742 BEACH BLVD STE 240, HUNTINGTON BEACH, CA 92647-6835
(714) 842-0444
(714) 842-8444
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA60097518
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2003083
—
WA
05
—
500636969
—
OR
Enumeration date
06/16/2009
Last updated
09/28/2021
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