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General NPI Number Information
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NPI Number | 1265721146
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Entity Type | Individual
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Provider Name | CARYN AUDREY CARROLL L.AC.
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Gender | Female
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Dates
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Enumeration Date | 03/31/2011
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Last Update Date | 03/31/2011
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Provider Practice Location Address
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Address Line | 744 EAST MAIN ST.
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City | VENTURA
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State | CA
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Zip | 93001
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Country | US
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Telephone | 805-407-3600
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Fax |
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Provider Business Mailing Address
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Address Line | 2859 MOHAWK AVE
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City | VENTURA
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State | CA
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Zip | 93001-1220
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Country | US
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Telephone | 805-407-3600
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | AC 9992
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License Number State | CA
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