Individual
MS. CARLA MARIA FOUNTAIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CMT
Contact information
Practice address
2360 CARROTWOOD DR, BREA, CA 92821-4617
(714) 321-9938
Mailing address
2360 CARROTWOOD DR, BREA, CA 92821-4617
(714) 321-9938
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
1361
CA
Other
Enumeration date
10/21/2020
Last updated
10/21/2020
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