Provider Demographics
NPI:1205957735
Name:C ALDWELL, NARRYE DAVIS (LAC)
Entity type:Individual
Prefix:
First Name:NARRYE
Middle Name:DAVIS
Last Name:C ALDWELL
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 1:5344 TAYLOR WAY
Mailing Address - Street 2:
Mailing Address - City:FELTON
Mailing Address - State:CA
Mailing Address - Zip Code:95018-9267
Mailing Address - Country:US
Mailing Address - Phone:408-489-8268
Mailing Address - Fax:
Practice Address - Street 1:1685 WESTWOOD DR
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95125-5104
Practice Address - Country:US
Practice Address - Phone:408-489-8268
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 3751171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist