Provider Demographics
NPI:1164684171
Name:FRIEDMAN, CARLA RACHEL (LMP)
Entity Type:Individual
Prefix:MS
First Name:CARLA
Middle Name:RACHEL
Last Name:FRIEDMAN
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 OAKLEY LN
Mailing Address - Street 2:
Mailing Address - City:TAOS
Mailing Address - State:NM
Mailing Address - Zip Code:87571-4386
Mailing Address - Country:US
Mailing Address - Phone:575-751-0045
Mailing Address - Fax:
Practice Address - Street 1:110 OAKLEY LN
Practice Address - Street 2:
Practice Address - City:TAOS
Practice Address - State:NM
Practice Address - Zip Code:87571-4386
Practice Address - Country:US
Practice Address - Phone:575-751-0045
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-30
Last Update Date:2008-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM4755225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist