Individual
MR. CHARLIE CAVALLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LAC
Contact information
Practice address
1325 CHORRO ST, SAN LUIS OBISPO, CA 93401-4005
(503) 929-6416
Mailing address
1732 TIERRA NUEVA LN, OCEANO, CA 93445-9126
(503) 929-6416
Taxonomy
Speciality
Code
Description
License number
State
171100000X
Acupuncturist
Primary
18998
CA
225700000X
Massage Therapist
16249
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
18998
CALIFORNIA STATE ACUPUNCTURE LICENSE
CA
Enumeration date
01/28/2013
Last updated
02/25/2025
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