Provider Demographics
NPI:1881010858
Name:CAUDILLO, PAUL CHARLES (DPT)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:CHARLES
Last Name:CAUDILLO
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5337 TRUXTUN AVE.
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93309-0641
Mailing Address - Country:US
Mailing Address - Phone:661-328-0650
Mailing Address - Fax:661-328-0654
Practice Address - Street 1:4605 BUENA VISTA RD STE 680
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93311-8793
Practice Address - Country:US
Practice Address - Phone:661-282-8737
Practice Address - Fax:661-735-5581
Is Sole Proprietor?:No
Enumeration Date:2014-03-13
Last Update Date:2020-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT41149225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist