Provider Demographics
NPI:1477101178
Name:CALL, CARMEN (LAC)
Entity Type:Individual
Prefix:
First Name:CARMEN
Middle Name:
Last Name:CALL
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 1:3077 MILES WAY APT 3
Mailing Address - Street 2:
Mailing Address - City:PLACERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95667-6552
Mailing Address - Country:US
Mailing Address - Phone:510-326-6912
Mailing Address - Fax:
Practice Address - Street 1:3077 MILES WAY APT 3
Practice Address - Street 2:
Practice Address - City:PLACERVILLE
Practice Address - State:CA
Practice Address - Zip Code:95667-6552
Practice Address - Country:US
Practice Address - Phone:510-326-6912
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-27
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18584171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist