Healthcare Provider Details

I. General information

NPI: 1881010858
Provider Name (Legal Business Name): PAUL CHARLES CAUDILLO D.P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2014
Last Update Date: 03/25/2020
Certification Date: 03/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4605 BUENA VISTA RD STE 680
BAKERSFIELD CA
93311-8793
US

IV. Provider business mailing address

5337 TRUXTUN AVE.
BAKERSFIELD CA
93309-0641
US

V. Phone/Fax

Practice location:
  • Phone: 661-282-8737
  • Fax: 661-735-5581
Mailing address:
  • Phone: 661-328-0650
  • Fax: 661-328-0654

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT41149
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: