Basic Information
Provider Information
NPI: 1508956251
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: REEVES
FirstName: CARLA
MiddleName: M
NamePrefix:  
NameSuffix:  
Credential: CNM
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 325 DISTEL CIR
Address2:  
City: LOS ALTOS
State: CA
PostalCode: 940221408
CountryCode: US
TelephoneNumber: 5104982933
FaxNumber:  
Practice Location
Address1: 3200 KEARNEY STREET
Address2:  
City: FREMONT
State: CA
PostalCode: 954382299
CountryCode: US
TelephoneNumber: 5104901222
FaxNumber:  
Other Information
ProviderEnumerationDate: 10/13/2006
LastUpdateDate: 03/04/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 03/04/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
367A00000XCNM37CAY Physician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife 

No ID Information.


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