Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 258060 | NY |
NPI | 1003136243 |
---|---|
Provider Name | Sandra Carrera |
First Address | Rosedale, NY 11422-2241 |
Second Address | Sunnyside, NY 11104-3004 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/06/2010 |
Last Update Date | 01/09/2015 |