Healthcare Provider Details

I. General information

NPI: 1205223831
Provider Name (Legal Business Name): CAITLYN MARIE HARRISON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2015
Last Update Date: 12/02/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 PASTEUR DR STANFORD MEDICINE RESIDENCY OFFICE, LANE 154
STANFORD CA
94305-2200
US

IV. Provider business mailing address

300 PASTEUR DR
STANFORD CA
94305-2200
US

V. Phone/Fax

Practice location:
  • Phone: 650-725-2181
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207U00000X
TaxonomyNuclear Medicine Physician
License Number62750
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: