Healthcare Provider Details

I. General information

NPI: 1750097747
Provider Name (Legal Business Name): CAITLIN ELISE AZEMAR MS, DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CAITLIN ELISE HALL

II. Dates (important events)

Enumeration Date: 01/24/2023
Last Update Date: 04/10/2026
Certification Date: 04/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1310 CLUB DR
VALLEJO CA
94592-1187
US

IV. Provider business mailing address

350 HAWTHORNE AVE
OAKLAND CA
94609-3108
US

V. Phone/Fax

Practice location:
  • Phone: 707-638-5970
  • Fax:
Mailing address:
  • Phone: 510-869-8751
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: