Healthcare Provider Details

I. General information

NPI: 1508246067
Provider Name (Legal Business Name): CAITLIN OUTLAND PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CAITLIN MORGAN PA-C

II. Dates (important events)

Enumeration Date: 05/31/2015
Last Update Date: 03/11/2025
Certification Date: 03/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4455 W 117TH ST STE 300
HAWTHORNE CA
90250-2240
US

IV. Provider business mailing address

4455 W 117TH ST STE 300
HAWTHORNE CA
90250-2240
US

V. Phone/Fax

Practice location:
  • Phone: 310-645-0444
  • Fax: 310-978-0599
Mailing address:
  • Phone: 310-645-0444
  • Fax: 310-978-0599

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number52528
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: