Provider Demographics
NPI:1205566841
Name:REID, CAITLIN SARAH (PA)
Entity type:Individual
Prefix:
First Name:CAITLIN
Middle Name:SARAH
Last Name:REID
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:39350 CIVIC CENTER DR #300
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538
Mailing Address - Country:US
Mailing Address - Phone:510-797-3933
Mailing Address - Fax:510-975-5184
Practice Address - Street 1:39350 CIVIC CENTER DR #300
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538
Practice Address - Country:US
Practice Address - Phone:510-797-3933
Practice Address - Fax:510-975-5184
Is Sole Proprietor?:No
Enumeration Date:2022-06-15
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
363A00000X
CA61410363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant