Provider Demographics
NPI:1053497107
Name:CAOILI, RAUL L (LAC)
Entity Type:Individual
Prefix:
First Name:RAUL
Middle Name:L
Last Name:CAOILI
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1615 SWEETWATER RD
Mailing Address - Street 2:SUITE J
Mailing Address - City:NATIONAL CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91950-7655
Mailing Address - Country:US
Mailing Address - Phone:619-474-8649
Mailing Address - Fax:619-474-8818
Practice Address - Street 1:1615 SWEETWATER RD
Practice Address - Street 2:SUITE J
Practice Address - City:NATIONAL CITY
Practice Address - State:CA
Practice Address - Zip Code:91950-7655
Practice Address - Country:US
Practice Address - Phone:619-474-8649
Practice Address - Fax:619-474-8818
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2015-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC8111171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA261182270OtherCALIFORNIA TAX