Provider Demographics
NPI:1356672521
Name:NERELLI, CARLA MARIE (LAC)
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:MARIE
Last Name:NERELLI
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1306 COSTA BRAVA
Mailing Address - Street 2:
Mailing Address - City:PISMO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:93449-3306
Mailing Address - Country:US
Mailing Address - Phone:858-232-6866
Mailing Address - Fax:
Practice Address - Street 1:2066 CHORRO ST
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-5207
Practice Address - Country:US
Practice Address - Phone:805-242-6852
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-27
Last Update Date:2012-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13356171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist