Healthcare Provider Details

I. General information

NPI: 1720411580
Provider Name (Legal Business Name): CAITLIN COLVARD M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2013
Last Update Date: 07/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1520 RODNEY DR 404
LOS ANGELES CA
90027-5338
US

IV. Provider business mailing address

1520 RODNEY DR 404
LOS ANGELES CA
90027-5338
US

V. Phone/Fax

Practice location:
  • Phone: 323-361-2122
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA125416
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: