MEDICARE: DR. MARISSA CAUDILL MD, PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	A106990	CA

General Provider Information

NPI Number	:	1578717468
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARISSA CAUDILL MD, PHD

Provider Business Mailing Address
First Line	:	21243 VENTURA BLVD
Second Line	:	STE 243
City	:	WOODLAND HILLS
State	:	CA
Zip	:	91364-2168
Country	:	US
Telephone Number	:	424-270-0744
Fax Number	:	424-270-0744

Provider Business Practice Location Address
First Line	:	21243 VENTURA BLVD
Second Line	:	STE 243
City	:	WOODLAND HILLS
State	:	CA
Zip	:	91364-2168
Country	:	US
Telephone Number	:	424-270-0744
Fax Number	:	424-270-0744

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/05/2008
Last Update Date	:	11/30/2021

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