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General NPI Number Information
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NPI Number | 1457937393
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Entity Type | Individual
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Provider Name | MS. CAITLYN M WILD
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Gender | Female
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Dates
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Enumeration Date | 03/22/2021
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Last Update Date | 04/18/2024
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Provider Practice Location Address
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Address Line | 7090 MIRATECH DR, SAN DIEGO,
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City | SAN DIEGO
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State | CA
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Zip | 92121-9212
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Country | US
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Telephone | 858-304-6440
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Fax |
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Provider Business Mailing Address
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Address Line | 5245 W 138TH PL
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City | HAWTHORNE
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State | CA
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Zip | 90250-6435
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Country | US
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Telephone | 310-418-5531
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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 | 225XP0200X
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Taxonomy Name | Pediatric Occupational Therapist
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License Number | 26297
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License Number State | CA
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