Provider Demographics
NPI:1164549960
Name:CALDWELL, FIONA MACKENZIE (PT)
Entity Type:Individual
Prefix:MS
First Name:FIONA
Middle Name:MACKENZIE
Last Name:CALDWELL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1284 HAVENHURST DR
Mailing Address - Street 2:APT. #107
Mailing Address - City:WEST HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90046-4956
Mailing Address - Country:US
Mailing Address - Phone:323-822-0795
Mailing Address - Fax:
Practice Address - Street 1:1284 HAVENHURST DR
Practice Address - Street 2:APT. #107
Practice Address - City:WEST HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90046-4956
Practice Address - Country:US
Practice Address - Phone:323-822-0795
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT16981174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist