Provider Demographics
NPI:1194157834
Name:MAYO, CAROLYN O'CONNELL (MS, LAC)
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:O'CONNELL
Last Name:MAYO
Suffix:
Gender:F
Credentials:MS, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4153 PIEDMONT AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94611-5108
Mailing Address - Country:US
Mailing Address - Phone:510-817-4538
Mailing Address - Fax:510-291-2286
Practice Address - Street 1:4153 PIEDMONT AVE APT 1
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94611-5108
Practice Address - Country:US
Practice Address - Phone:510-333-0695
Practice Address - Fax:510-291-2286
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-05
Last Update Date:2016-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15473171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist