Provider Demographics
NPI:1073988960
Name:POLLAND, CARLY (ND)
Entity type:Individual
Prefix:
First Name:CARLY
Middle Name:
Last Name:POLLAND
Suffix:
Gender:
Credentials:ND
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 31
Mailing Address - Street 2:
Mailing Address - City:RESCUE
Mailing Address - State:CA
Mailing Address - Zip Code:95672-0031
Mailing Address - Country:US
Mailing Address - Phone:916-917-1779
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 31
Practice Address - Street 2:
Practice Address - City:RESCUE
Practice Address - State:CA
Practice Address - Zip Code:95672-0031
Practice Address - Country:US
Practice Address - Phone:916-907-1779
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-03
Last Update Date:2025-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61077803175F00000X
CAND764175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath