Healthcare Provider Details

I. General information

NPI: 1851693451
Provider Name (Legal Business Name): NAZANEEN CAUTHRON PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2010
Last Update Date: 01/13/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2755 ALAMO ST STE 100
SIMI VALLEY CA
93065-1345
US

IV. Provider business mailing address

2755 ALAMO ST STE 100
SIMI VALLEY CA
93065-1345
US

V. Phone/Fax

Practice location:
  • Phone: 805-210-7400
  • Fax: 805-210-7416
Mailing address:
  • Phone: 805-210-7400
  • Fax: 805-210-7416

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA428
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA51563
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: