=====================================================
General NPI Number Information
=====================================================
NPI Number | 1184021800
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CAOS, A MEDICAL CORPORATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/24/2014
-----------------------------------------------------
Last Update Date | 05/18/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2655 CAMINO DEL RIO N STE 330
-----------------------------------------------------
City | SAN DIEGO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92108-1633
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 619-260-6300
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1035 PLACER ST
-----------------------------------------------------
City | REDDING
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 96001-1125
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHYSICIAN ASSISTANT
-----------------------------------------------------
Name | MRS. KRISTEN NOEL ANDERSON
-----------------------------------------------------
Credential | PA-C
-----------------------------------------------------
Telephone | 530-410-3675
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number | PA52159
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------