Healthcare Provider Details

I. General information

NPI: 1033003264
Provider Name (Legal Business Name): CAROLINE CLINE
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2025
Last Update Date: 06/03/2025
Certification Date: 06/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 S LOS ROBLES AVE # 501
PASADENA CA
91101-2453
US

IV. Provider business mailing address

1311 MOHAWK ST
LOS ANGELES CA
90026-2442
US

V. Phone/Fax

Practice location:
  • Phone: 626-564-3016
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number985263
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: