Healthcare Provider Details

I. General information

NPI: 1558101329
Provider Name (Legal Business Name): CAITLIN DALE BURT NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2024
Last Update Date: 08/26/2025
Certification Date: 08/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

747 52ND ST
OAKLAND CA
94609-1809
US

IV. Provider business mailing address

747 52ND ST
OAKLAND CA
94609-1809
US

V. Phone/Fax

Practice location:
  • Phone: 510-428-3000
  • Fax:
Mailing address:
  • Phone: 510-428-3000
  • Fax: 510-597-7169

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number95025956
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: