Healthcare Provider Details

I. General information

NPI: 1205348059
Provider Name (Legal Business Name): CLARA P CAUDILLO PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CLARA PRINCESS ATKINS

II. Dates (important events)

Enumeration Date: 11/02/2017
Last Update Date: 06/09/2022
Certification Date: 06/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3440 E LA PALMA AVE
ANAHEIM CA
92806-2020
US

IV. Provider business mailing address

1924 LOS ALAMITOS DR
PLACENTIA CA
92870-5511
US

V. Phone/Fax

Practice location:
  • Phone: 714-644-2000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number294223
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: