Healthcare Provider Details

I. General information

NPI: 1578020012
Provider Name (Legal Business Name): CARLA LEIGH PAOLI LVN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/20/2019
Last Update Date: 02/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2945 MCMILLAN AVE STE 240
SAN LUIS OBISPO CA
93401-6771
US

IV. Provider business mailing address

2945 MCMILLAN AVE STE 240
SAN LUIS OBISPO CA
93401-6771
US

V. Phone/Fax

Practice location:
  • Phone: 805-439-4890
  • Fax: 805-788-2506
Mailing address:
  • Phone: 805-439-4890
  • Fax: 805-788-2506

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License NumberVN28515
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: