Healthcare Provider Details

I. General information

NPI: 1053099408
Provider Name (Legal Business Name): CARLYNN CAPOZZA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CARLY CAPOZZA

II. Dates (important events)

Enumeration Date: 07/06/2023
Last Update Date: 07/06/2023
Certification Date: 07/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2386 FARADAY AVE STE 140
CARLSBAD CA
92008-7222
US

IV. Provider business mailing address

2386 FARADAY AVE STE 140
CARLSBAD CA
92008-7222
US

V. Phone/Fax

Practice location:
  • Phone: 760-496-9394
  • Fax:
Mailing address:
  • Phone: 760-496-9394
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberAMFT139793
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: