Healthcare Provider Details

I. General information

NPI: 1922374404
Provider Name (Legal Business Name): CLAUDIA KAROLINE MEDL D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2012
Last Update Date: 03/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1627 GATES AVE
MANHATTAN BEACH CA
90266-7028
US

IV. Provider business mailing address

1627 GATES AVE
MANHATTAN BEACH CA
90266-7028
US

V. Phone/Fax

Practice location:
  • Phone: 310-376-3404
  • Fax:
Mailing address:
  • Phone: 310-376-3404
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NN1001X
TaxonomyNutrition Chiropractor
License Number16627
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: