Provider Demographics
NPI:1073834297
Name:MCCLURE, CARLA BERYL (LAC; OMD; DIPLOM)
Entity type:Individual
Prefix:
First Name:CARLA
Middle Name:BERYL
Last Name:MCCLURE
Suffix:
Gender:F
Credentials:LAC; OMD; DIPLOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3962
Mailing Address - Street 2:
Mailing Address - City:TRUCKEE
Mailing Address - State:CA
Mailing Address - Zip Code:96160-3962
Mailing Address - Country:US
Mailing Address - Phone:530-386-4851
Mailing Address - Fax:
Practice Address - Street 1:12710 NORTHWOODS BLVD STE 6
Practice Address - Street 2:
Practice Address - City:TRUCKEE
Practice Address - State:CA
Practice Address - Zip Code:96161-6395
Practice Address - Country:US
Practice Address - Phone:530-386-4851
Practice Address - Fax:530-562-4652
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-22
Last Update Date:2025-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV2012171100000X
CA13724171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist