Healthcare Provider Details

I. General information

NPI: 1316451388
Provider Name (Legal Business Name): CAITLIN STEIDING ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2017
Last Update Date: 11/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1265 EL CAMINO REAL STE 100
SANTA CLARA CA
95050-4257
US

IV. Provider business mailing address

531 SHADOW CT
SAN JOSE CA
95129-1942
US

V. Phone/Fax

Practice location:
  • Phone: 408-241-8326
  • Fax:
Mailing address:
  • Phone: 707-775-7159
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number2000029542
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: