Provider Demographics
NPI:1790104636
Name:TOTH, CARLA MARIE (LAC)
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:MARIE
Last Name:TOTH
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:128 W 14TH ST
Mailing Address - Street 2:SUITE A2
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301-5100
Mailing Address - Country:US
Mailing Address - Phone:970-799-3470
Mailing Address - Fax:970-247-8838
Practice Address - Street 1:128 W 14TH ST
Practice Address - Street 2:SUITE A2
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-5100
Practice Address - Country:US
Practice Address - Phone:970-799-3470
Practice Address - Fax:970-247-8838
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-08
Last Update Date:2014-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO899171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist