Most Relevant Information
Provider Data
| NPI Number: | 1003662818 |
| Provider Name: | CARLY ELIZABETH DECERCE RAD-T LEVEL I |
| Entity Type: | Individual |
| Taxonomy Code: | 101YA0400X |
| Specialty: | Counselor |
| License Number: |
Most Important Dates
| Enumeration Date: | 04/24/2024 |
| Last Updated: | 04/24/2024 |
Provider Practice Location
1002 PICO BLVD
SANTA MONICA
CA
904051416
Practice Location Phone/Fax
| Phone: | 3108487132 |
| Fax: |
Provider Mailing Location
909 PICO BLVD
SANTA MONICA
CA
904051326
Provider Mailing Phone/Fax
| Phone: | 3108487132 |
| Fax: |