Provider Demographics
NPI:1356735583
Name:MARKS, CARLY
Entity type:Individual
Prefix:
First Name:CARLY
Middle Name:
Last Name:MARKS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CARLY
Other - Middle Name:
Other - Last Name:YOUNG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, IBCLC
Mailing Address - Street 1:13374 TERRAZA PLAYA CANCUN
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92124-1538
Mailing Address - Country:US
Mailing Address - Phone:619-481-1000
Mailing Address - Fax:
Practice Address - Street 1:13374 TERRAZA PLAYA CANCUN
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92124-1538
Practice Address - Country:US
Practice Address - Phone:619-481-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-25
Last Update Date:2015-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA665665163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA665665OtherREGISTERED NURSE
L-60664OtherIBCLC INTERNATIONAL BOARD CERTIFIED LACTATION CONSULTANT