Healthcare Provider Details

I. General information

NPI: 1780061853
Provider Name (Legal Business Name): CAITLYN SCHULL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/28/2015
Last Update Date: 04/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3402 E BROADWAY BLVD
TUCSON AZ
85716-5406
US

IV. Provider business mailing address

3402 E BROADWAY BLVD
TUCSON AZ
85716-5406
US

V. Phone/Fax

Practice location:
  • Phone: 520-405-9687
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86009009
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: