Healthcare Provider Details

I. General information

NPI: 1861154452
Provider Name (Legal Business Name): CARLY MCLARTY ND
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/11/2021
Last Update Date: 10/11/2021
Certification Date: 10/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

78900 AVENUE 47 STE 102
LA QUINTA CA
92253-2070
US

IV. Provider business mailing address

78650 AVENUE 42 APT 803
BERMUDA DUNES CA
92203-1352
US

V. Phone/Fax

Practice location:
  • Phone: 760-771-5970
  • Fax:
Mailing address:
  • Phone: 513-306-5963
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License NumberND1282
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: