Healthcare Provider Details

I. General information

NPI: 1235968900
Provider Name (Legal Business Name): ANDREW CAUDILLO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2024
Last Update Date: 07/30/2024
Certification Date: 07/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5170 GOLDEN FOOTHILL PKWY # 143
EL DORADO HILLS CA
95762-9608
US

IV. Provider business mailing address

5170 GOLDEN FOOTHILL PKWY # 143
EL DORADO HILLS CA
95762-9608
US

V. Phone/Fax

Practice location:
  • Phone: 916-280-1351
  • Fax:
Mailing address:
  • Phone: 916-280-1351
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: