Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175F00000X | Naturopath | ND764 | CA |
NPI | 1073988960 |
---|---|
Provider Name | Carly Polland |
First Address | El Dorado Hills, CA 95762-9319 |
Second Address | El Dorado Hills, CA 95762-9319 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/12/2015 |
Last Update Date | 04/02/2022 |