Healthcare Provider Details

I. General information

NPI: 1619306743
Provider Name (Legal Business Name): CARLA L SANDIEGO L.AC.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CARLA L SAN DIEGO L.AC.

II. Dates (important events)

Enumeration Date: 11/08/2013
Last Update Date: 10/28/2024
Certification Date: 10/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 CENTRAL AVE STE 2C
DOVER NH
03820-4042
US

IV. Provider business mailing address

130 CENTRAL AVE STE 2C
DOVER NH
03820-4042
US

V. Phone/Fax

Practice location:
  • Phone: 603-684-2413
  • Fax: 603-750-9136
Mailing address:
  • Phone: 603-684-2413
  • Fax: 603-750-9136

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number000783
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number25MZ00102700
License Number StateNJ
# 3
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number337
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: