Provider Demographics
NPI:1174707343
Name:CALL, DONNA MARIA (LICAC)
Entity type:Individual
Prefix:
First Name:DONNA
Middle Name:MARIA
Last Name:CALL
Suffix:
Gender:F
Credentials:LICAC
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 164
Mailing Address - Street 2:
Mailing Address - City:ELK
Mailing Address - State:CA
Mailing Address - Zip Code:95432-0164
Mailing Address - Country:US
Mailing Address - Phone:707-357-5162
Mailing Address - Fax:
Practice Address - Street 1:18300 OLD COAST HWY
Practice Address - Street 2:
Practice Address - City:FORT BRAGG
Practice Address - State:CA
Practice Address - Zip Code:95437-8205
Practice Address - Country:US
Practice Address - Phone:707-357-5162
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-24
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC11423225700000X, 171100000X
225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist