Provider Demographics
NPI:1053798371
Name:GHOBRIAL, CAROLINE A (PTA)
Entity type:Individual
Prefix:
First Name:CAROLINE
Middle Name:A
Last Name:GHOBRIAL
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10918 VILLA HERMOSA DR
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93311-9373
Mailing Address - Country:US
Mailing Address - Phone:626-543-0904
Mailing Address - Fax:
Practice Address - Street 1:3601 SAN DIMAS
Practice Address - Street 2:GOLDEN LIVING CENTER
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93301
Practice Address - Country:US
Practice Address - Phone:661-323-2894
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-06
Last Update Date:2015-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9777225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant