Provider Demographics
NPI:1275053126
Name:MONTUFAR, MARIA CAROLINA (LAC)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:CAROLINA
Last Name:MONTUFAR
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:CAROLINA
Other - Middle Name:
Other - Last Name:MONTUFAR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LAC
Mailing Address - Street 1:3425 GREGORY DR
Mailing Address - Street 2:
Mailing Address - City:BAY POINT
Mailing Address - State:CA
Mailing Address - Zip Code:94565-1512
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3425 GREGORY DR
Practice Address - Street 2:
Practice Address - City:BAY POINT
Practice Address - State:CA
Practice Address - Zip Code:94565-1512
Practice Address - Country:US
Practice Address - Phone:925-421-4896
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-22
Last Update Date:2017-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC17669171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAC17669OtherSTATE OF CALIFORNIA ACUPUNCTURE BOARD