Provider Demographics
NPI:1649737909
Name:ARIETA, CARLA (LAC)
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:
Last Name:ARIETA
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:CARLA
Other - Middle Name:
Other - Last Name:ARIETA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LAC
Mailing Address - Street 1:683 OLD MILL RD
Mailing Address - Street 2:
Mailing Address - City:MILLERSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21108-1326
Mailing Address - Country:US
Mailing Address - Phone:410-846-9067
Mailing Address - Fax:
Practice Address - Street 1:683 OLD MILL RD
Practice Address - Street 2:
Practice Address - City:MILLERSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21108-1326
Practice Address - Country:US
Practice Address - Phone:410-846-9067
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-22
Last Update Date:2019-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU02557171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist