Healthcare Provider Details

I. General information

NPI: 1740104470
Provider Name (Legal Business Name): MRS. VALERIE CECELIA CAUDILLO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2026
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

232 E GISH RD
SAN JOSE CA
95112-4706
US

IV. Provider business mailing address

1798 MAGNOLIA LAKE CT
SAN JOSE CA
95131-3517
US

V. Phone/Fax

Practice location:
  • Phone: 408-832-7443
  • Fax:
Mailing address:
  • Phone: 408-832-7443
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License NumberD1743500
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: