Provider Demographics
NPI:1447540083
Name:STILLWELL, CARLA TAKAHASHI (MD)
Entity type:Individual
Prefix:DR
First Name:CARLA
Middle Name:TAKAHASHI
Last Name:STILLWELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2402 LA PLANCHA LN
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92009-9127
Mailing Address - Country:US
Mailing Address - Phone:760-633-1216
Mailing Address - Fax:
Practice Address - Street 1:22 W 35TH ST STE 101
Practice Address - Street 2:
Practice Address - City:NATIONAL CITY
Practice Address - State:CA
Practice Address - Zip Code:91950-7926
Practice Address - Country:US
Practice Address - Phone:619-427-3361
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-16
Last Update Date:2024-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA114687207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine