Healthcare Provider Details

I. General information

NPI: 1144824186
Provider Name (Legal Business Name): CAITLIN VALDEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2020
Last Update Date: 03/08/2023
Certification Date: 06/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4361 RAILROAD AVE
PLEASANTON CA
94566-6611
US

IV. Provider business mailing address

2400 SHADY WILLOW LN UNIT 30F
BRENTWOOD CA
94513-3738
US

V. Phone/Fax

Practice location:
  • Phone: 925-462-1755
  • Fax:
Mailing address:
  • Phone: 925-895-4496
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: