Healthcare Provider Details

I. General information

NPI: 1407847007
Provider Name (Legal Business Name): CAITLIN MARIE LAFFERTY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2005
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2201 MISSION AVE STE 200
OCEANSIDE CA
92058-2313
US

IV. Provider business mailing address

3332 WALDEN AVE SUITE 110
DEPEW NY
14043
US

V. Phone/Fax

Practice location:
  • Phone: 760-826-7223
  • Fax:
Mailing address:
  • Phone: 716-668-7051
  • Fax: 716-668-7069

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95041100
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberF305204-1
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number0001339767
License Number StateVA
# 4
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberF4207541
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: