Healthcare Provider Details

I. General information

NPI: 1720329659
Provider Name (Legal Business Name): CHRISTINA L. MCCAULEY DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2013
Last Update Date: 07/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 W PROVIDENCE AVE
ORANGE CA
92868-3892
US

IV. Provider business mailing address

1301 W PROVIDENCE AVE
ORANGE CA
92868-3892
US

V. Phone/Fax

Practice location:
  • Phone: 714-639-4990
  • Fax: 714-602-2934
Mailing address:
  • Phone: 714-639-4990
  • Fax: 714-602-2934

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number39914
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: