Healthcare Provider Details

I. General information

NPI: 1609814086
Provider Name (Legal Business Name): ANTONIO C LACARRA AU.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2006
Last Update Date: 10/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1244 UNIVERSITY AVE
SAN DIEGO CA
92103-3312
US

IV. Provider business mailing address

7910 FROST ST STE 420
SAN DIEGO CA
92123-2765
US

V. Phone/Fax

Practice location:
  • Phone: 619-291-0030
  • Fax:
Mailing address:
  • Phone: 619-569-6090
  • Fax: 619-569-0672

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number1474
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: