Provider Demographics
NPI:1245922525
Name:KAROLAK, LIBERTY (LAC)
Entity type:Individual
Prefix:
First Name:LIBERTY
Middle Name:
Last Name:KAROLAK
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 1:138 W FREDDIE CANYON WAY
Mailing Address - Street 2:
Mailing Address - City:ORO VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85755-1632
Mailing Address - Country:US
Mailing Address - Phone:970-404-1810
Mailing Address - Fax:
Practice Address - Street 1:8700 E TANQUE VERDE RD STE 100
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85749-5701
Practice Address - Country:US
Practice Address - Phone:520-398-4900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-24
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLAC-012164171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist