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General NPI Number Information
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NPI Number | 1275629958
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Entity Type | Individual
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Provider Name | BRENDA K. CAILLOUEL BS, DDS, MSD
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Gender | Female
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Dates
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Enumeration Date | 10/04/2006
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Last Update Date | 12/17/2009
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Provider Practice Location Address
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Address Line | 3936 LA JOLLA VILLAGE DR
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City | LA JOLLA
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State | CA
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Zip | 92037-1418
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Country | US
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Telephone | 858-202-0393
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Fax |
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Provider Business Mailing Address
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Address Line | 2466 AZURE COAST DR
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City | LA JOLLA
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State | CA
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Zip | 92037-3508
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Country | US
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Telephone | 858-222-2454
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 46565
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DN-16530
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DT-2186
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License Number State | HI
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