Healthcare Provider Details

I. General information

NPI: 1376259192
Provider Name (Legal Business Name): MEGAN CAUDILLO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/25/2023
Last Update Date: 01/25/2023
Certification Date: 01/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 W DUARTE RD
MONROVIA CA
91016-4436
US

IV. Provider business mailing address

15146 LA CALMA DR
WHITTIER CA
90605-1618
US

V. Phone/Fax

Practice location:
  • Phone: 626-358-4547
  • Fax:
Mailing address:
  • Phone: 562-544-4963
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: