Healthcare Provider Details

I. General information

NPI: 1376881789
Provider Name (Legal Business Name): CAITLIN ANNVELMA WINDSOR BA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2013
Last Update Date: 02/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 E ALESSANDRO BLVD STE 3C
RIVERSIDE CA
92508-2464
US

IV. Provider business mailing address

301 E ALESSANDRO BLVD STE 3C
RIVERSIDE CA
92508-2464
US

V. Phone/Fax

Practice location:
  • Phone: 951-329-9590
  • Fax: 951-335-8622
Mailing address:
  • Phone: 951-329-9590
  • Fax: 951-335-8622

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberHA 7610
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: