Provider Demographics
NPI:1043986557
Name:KUCARIC, KRISTO JR (L AC)
Entity type:Individual
Prefix:MR
First Name:KRISTO
Middle Name:
Last Name:KUCARIC
Suffix:JR
Gender:M
Credentials:L AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1241 JOHNSON AVE # 137
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-3306
Mailing Address - Country:US
Mailing Address - Phone:619-822-0843
Mailing Address - Fax:805-855-4178
Practice Address - Street 1:1335 BROAD ST STE A
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-1932
Practice Address - Country:US
Practice Address - Phone:805-395-6881
Practice Address - Fax:805-855-4178
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-17
Last Update Date:2025-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171100000X
CA16130171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist