Provider Demographics
NPI:1972904241
Name:CHAUDOIR, MOLLY (LAC)
Entity type:Individual
Prefix:
First Name:MOLLY
Middle Name:
Last Name:CHAUDOIR
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4170 GROSS RD. EXT.
Mailing Address - Street 2:SUITE 6
Mailing Address - City:CAPITOLA
Mailing Address - State:CA
Mailing Address - Zip Code:95010
Mailing Address - Country:US
Mailing Address - Phone:831-464-1605
Mailing Address - Fax:831-464-1638
Practice Address - Street 1:4170 GROSS RD. EXT.
Practice Address - Street 2:SUITE 6
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95010
Practice Address - Country:US
Practice Address - Phone:831-464-1605
Practice Address - Fax:831-464-1605
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-05
Last Update Date:2014-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACA 15989171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist