Healthcare Provider Details

I. General information

NPI: 1396573937
Provider Name (Legal Business Name): CAITLIN ALYSE DAVIS AUD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2024
Last Update Date: 07/24/2024
Certification Date: 07/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2655 1ST ST STE 170
SIMI VALLEY CA
93065-1565
US

IV. Provider business mailing address

2655 1ST ST STE 170
SIMI VALLEY CA
93065-1565
US

V. Phone/Fax

Practice location:
  • Phone: 805-584-3327
  • Fax: 805-584-3329
Mailing address:
  • Phone: 805-584-3327
  • Fax: 805-584-3329

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License NumberAU3770
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAU3770
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: