Provider Demographics
NPI:1871208009
Name:CARITOS, MARY JOY (NP)
Entity type:Individual
Prefix:MS
First Name:MARY JOY
Middle Name:
Last Name:CARITOS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21724 RAVENNA AVE
Mailing Address - Street 2:
Mailing Address - City:CARSON
Mailing Address - State:CA
Mailing Address - Zip Code:90745-3129
Mailing Address - Country:US
Mailing Address - Phone:310-381-9381
Mailing Address - Fax:
Practice Address - Street 1:21724 RAVENNA AVE
Practice Address - Street 2:
Practice Address - City:CARSON
Practice Address - State:CA
Practice Address - Zip Code:90745-3129
Practice Address - Country:US
Practice Address - Phone:310-381-9381
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-23
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95022930363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology