Healthcare Provider Details

I. General information

NPI: 1063779353
Provider Name (Legal Business Name): CARA ORTIZ L.AC.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/12/2012
Last Update Date: 04/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7036 SANTERO WAY
COTATI CA
94931-4517
US

IV. Provider business mailing address

7036 SANTERO WAY
COTATI CA
94931-4517
US

V. Phone/Fax

Practice location:
  • Phone: 707-972-5792
  • Fax:
Mailing address:
  • Phone: 707-972-5792
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberCA 14801
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: