Basic Information
| Provider Information | |||||||||
| NPI: | 1003462722 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PARK | ||||||||
| FirstName: | CAITLYN | ||||||||
| MiddleName: | JEEIN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7212 ORANGETHORPE AVE STE 9A | ||||||||
| Address2: | |||||||||
| City: | BUENA PARK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 906214668 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7145036550 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 7212 ORANGETHORPE AVE STE 9A | ||||||||
| Address2: | |||||||||
| City: | BUENA PARK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 906214668 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7145036550 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/18/2019 | ||||||||
| LastUpdateDate: | 07/01/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/01/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WC0200X | 95160347 | CA | N | Nursing Service Providers | Registered Nurse | Critical Care Medicine | 363LF0000X | 95017087 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.