=====================================================
General NPI Number Information
=====================================================
NPI Number | 1982006573
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CAOS, A MEDICAL CORPORATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/25/2014
-----------------------------------------------------
Last Update Date | 12/06/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2655 CAMINO DEL RIO SUITE #330
-----------------------------------------------------
City | SAN DIEGO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92108-1633
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 619-260-6300
-----------------------------------------------------
Fax | 858-373-2446
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2655 CAMINO DEL RIO SUITE #330
-----------------------------------------------------
City | SAN DIEGO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92108-1633
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 619-260-6300
-----------------------------------------------------
Fax | 858-373-2446
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICER
-----------------------------------------------------
Name | KATHY KONDAS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 973-251-1132
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QH0100X
-----------------------------------------------------
Taxonomy Name | Health Service Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------