Provider Demographics
NPI:1619306743
Name:SANDIEGO, CARLA L (LAC)
Entity type:Individual
Prefix:
First Name:CARLA
Middle Name:L
Last Name:SANDIEGO
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:CARLA
Other - Middle Name:L
Other - Last Name:SAN DIEGO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LAC
Mailing Address - Street 1:130 CENTRAL AVE STE 2C
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:NH
Mailing Address - Zip Code:03820-4042
Mailing Address - Country:US
Mailing Address - Phone:603-684-2413
Mailing Address - Fax:603-750-9136
Practice Address - Street 1:130 CENTRAL AVE STE 2C
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:NH
Practice Address - Zip Code:03820-4042
Practice Address - Country:US
Practice Address - Phone:603-684-2413
Practice Address - Fax:603-750-9136
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-08
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000783171100000X
NJ25MZ00102700171100000X
NH337171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty