Individual
CAROL JOY PROVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2710 MIDDLEFIELD RD, REDWOOD CITY, CA 94063-3404
(650) 573-2222
Mailing address
2710 MIDDLEFIELD RD, FAIR OAKS CHILDRENS CLINIC, REDWOOD CITY, CA 94063
(650) 573-2222
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
A25599
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A255990
—
CA
Enumeration date
01/17/2007
Last updated
07/08/2007
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