Healthcare Provider Details

I. General information

NPI: 1144733668
Provider Name (Legal Business Name): CAOILIN HOCTOR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2017
Last Update Date: 12/04/2020
Certification Date: 12/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1608 S J ST FL 5
TACOMA WA
98405-4930
US

IV. Provider business mailing address

1608 S J ST FL 5
TACOMA WA
98405-4930
US

V. Phone/Fax

Practice location:
  • Phone: 253-274-7505
  • Fax: 253-590-0260
Mailing address:
  • Phone: 253-274-7505
  • Fax: 253-590-0260

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA60813187
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number207T00000X
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: