Provider Demographics
NPI:1073988960
Name:POLLAND, CARLY (ND)
Entity Type:Individual
Prefix:
First Name:CARLY
Middle Name:
Last Name:POLLAND
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5000 WINDPLAY DR STE 2
Mailing Address - Street 2:
Mailing Address - City:EL DORADO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:95762-9319
Mailing Address - Country:US
Mailing Address - Phone:916-974-9907
Mailing Address - Fax:
Practice Address - Street 1:9801 FAIR OAKS BLVD STE 400
Practice Address - Street 2:
Practice Address - City:FAIR OAKS
Practice Address - State:CA
Practice Address - Zip Code:95628-7051
Practice Address - Country:US
Practice Address - Phone:916-907-1779
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-03
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAND764175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath