Healthcare Provider Details

I. General information

NPI: 1528868197
Provider Name (Legal Business Name): KIKI-LEI L CAUTHEN MEDICAL ASSISTANT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/13/2025
Last Update Date: 03/13/2025
Certification Date: 03/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 WEBER ST
STRATFORD CT
06614-5236
US

IV. Provider business mailing address

415 BOSTON POST RD
MILFORD CT
06460-2578
US

V. Phone/Fax

Practice location:
  • Phone: 203-293-8696
  • Fax:
Mailing address:
  • Phone: 203-293-8696
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: