Individual
SONGSUDA CARLSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
7296 CAMINITO CARLOTTA, SAN DIEGO, CA 92120-2214
(858) 775-3829
Mailing address
7296 CAMINITO CARLOTTA, SAN DIEGO, CA 92120-2214
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
68815
CA
225700000X
Massage Therapist
Primary
68815
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
920175571-01
SHARP HEALTHCARE
CA
Enumeration date
05/26/2022
Last updated
05/26/2022
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