Healthcare Provider Details

I. General information

NPI: 1053497107
Provider Name (Legal Business Name): RAUL L. CAOILI L.AC.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2006
Last Update Date: 04/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1615 SWEETWATER RD SUITE J
NATIONAL CITY CA
91950-7655
US

IV. Provider business mailing address

1615 SWEETWATER RD SUITE J
NATIONAL CITY CA
91950-7655
US

V. Phone/Fax

Practice location:
  • Phone: 619-474-8649
  • Fax: 619-474-8818
Mailing address:
  • Phone: 619-474-8649
  • Fax: 619-474-8818

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC8111
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: