Healthcare Provider Details

I. General information

NPI: 1255725842
Provider Name (Legal Business Name): CAITLIN ELIZABETH DALE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2015
Last Update Date: 06/10/2025
Certification Date: 06/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

622 H ST
EUREKA CA
95501-1026
US

IV. Provider business mailing address

312 N ALMA SCHOOL RD STE 11
CHANDLER AZ
85224-4354
US

V. Phone/Fax

Practice location:
  • Phone: 707-443-4593
  • Fax:
Mailing address:
  • Phone: 623-300-5477
  • Fax: 800-725-1576

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2014034082
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number8142
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA65842
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: