Basic Information
| Provider Information | |||||||||
| NPI: | 1487619763 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CALDWELL | ||||||||
| FirstName: | EMILY | ||||||||
| MiddleName: | HELEN | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | N.P. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1245 WILSHIRE BLVD | ||||||||
| Address2: | STE 703 | ||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900174807 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2139777422 | ||||||||
| FaxNumber: | 2132508945 | ||||||||
| Practice Location | |||||||||
| Address1: | 1245 WILSHIRE BLVD | ||||||||
| Address2: | SUITE 703 | ||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900174807 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2139770419 | ||||||||
| FaxNumber: | 2132509416 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/19/2006 | ||||||||
| LastUpdateDate: | 12/08/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/08/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | NP13454 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | RN556937 | 05 | CA | MEDICAID | P00376593 | 01 | CA | MEDICARE RAILROAD | OTHER |