Provider Demographics
NPI:1437666567
Name:CAUDILLO, DIANA (FNP)
Entity Type:Individual
Prefix:MS
First Name:DIANA
Middle Name:
Last Name:CAUDILLO
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3935 S SAN JOAQUIN ST
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93277-3446
Mailing Address - Country:US
Mailing Address - Phone:559-901-4679
Mailing Address - Fax:
Practice Address - Street 1:3935 S SAN JOAQUIN ST
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93277-3446
Practice Address - Country:US
Practice Address - Phone:559-901-4679
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-10
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95008077363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily