Provider Demographics
NPI:1386039709
Name:GORLA, SALVATORE (LAC)
Entity Type:Individual
Prefix:
First Name:SALVATORE
Middle Name:
Last Name:GORLA
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 STATE FARM RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:BOONE
Mailing Address - State:NC
Mailing Address - Zip Code:28607-4738
Mailing Address - Country:US
Mailing Address - Phone:828-265-8668
Mailing Address - Fax:
Practice Address - Street 1:610 STATE FARM RD
Practice Address - Street 2:SUITE B
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28607-4738
Practice Address - Country:US
Practice Address - Phone:828-265-8668
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-02
Last Update Date:2015-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC265171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist