Provider Demographics
NPI:1477954873
Name:MCCUISTON, CAITLIN MAE (BA)
Entity Type:Individual
Prefix:
First Name:CAITLIN
Middle Name:MAE
Last Name:MCCUISTON
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:335 N 3RD ST APT 2
Mailing Address - Street 2:
Mailing Address - City:CAMPBELL
Mailing Address - State:CA
Mailing Address - Zip Code:95008-1241
Mailing Address - Country:US
Mailing Address - Phone:831-246-3380
Mailing Address - Fax:
Practice Address - Street 1:335 N 3RD ST APT 2
Practice Address - Street 2:
Practice Address - City:CAMPBELL
Practice Address - State:CA
Practice Address - Zip Code:95008-1241
Practice Address - Country:US
Practice Address - Phone:831-246-3380
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-05
Last Update Date:2014-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator