Provider Demographics
NPI:1578873311
Name:STANLEY, CAITLIN C
Entity Type:Individual
Prefix:
First Name:CAITLIN
Middle Name:C
Last Name:STANLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34324 YUCAIPA BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:YUCAIPA
Mailing Address - State:CA
Mailing Address - Zip Code:92399-2496
Mailing Address - Country:US
Mailing Address - Phone:909-790-0210
Mailing Address - Fax:909-797-9687
Practice Address - Street 1:34324 YUCAIPA BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:YUCAIPA
Practice Address - State:CA
Practice Address - Zip Code:92399-2496
Practice Address - Country:US
Practice Address - Phone:909-790-0210
Practice Address - Fax:909-797-9687
Is Sole Proprietor?:No
Enumeration Date:2010-10-14
Last Update Date:2010-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program