Provider Demographics
NPI:1679784953
Name:GORMAN, CAROL LOUISE (B S)
Entity type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:LOUISE
Last Name:GORMAN
Suffix:
Gender:F
Credentials:B S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1250 MORENA BLVD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92110-3815
Mailing Address - Country:US
Mailing Address - Phone:619-692-8718
Mailing Address - Fax:619-542-4969
Practice Address - Street 1:1250 MORENA BLVD
Practice Address - Street 2:SUITE 2
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92110-3815
Practice Address - Country:US
Practice Address - Phone:619-692-8718
Practice Address - Fax:619-542-4969
Is Sole Proprietor?:No
Enumeration Date:2007-05-25
Last Update Date:2011-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator