Healthcare Provider Details

I. General information

NPI: 1902304280
Provider Name (Legal Business Name): CAULFIELD BUSINESS GROUP, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2018
Last Update Date: 02/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

49 S BALDWIN AVE STE G
SIERRA MADRE CA
91024-2582
US

IV. Provider business mailing address

49 S BALDWIN AVE STE G
SIERRA MADRE CA
91024-2582
US

V. Phone/Fax

Practice location:
  • Phone: 626-355-5005
  • Fax:
Mailing address:
  • Phone: 626-355-5005
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License NumberCA12815
License Number StateCA

VIII. Authorized Official

Name: VANESSA CAULFIELD
Title or Position: VICE PRESIDENT
Credential:
Phone: 626-355-5005