Provider Demographics
NPI:1457721052
Name:SOURASKY OLMOS, KARLA (L AC)
Entity Type:Individual
Prefix:
First Name:KARLA
Middle Name:
Last Name:SOURASKY OLMOS
Suffix:
Gender:F
Credentials:L AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10752 N 89TH PL STE 209A
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-6251
Mailing Address - Country:US
Mailing Address - Phone:480-243-2453
Mailing Address - Fax:
Practice Address - Street 1:10752 N 89TH PL STE 209A
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-6251
Practice Address - Country:US
Practice Address - Phone:480-243-2453
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-25
Last Update Date:2019-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0980171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist