Provider Demographics
NPI:1336555697
Name:YESETA, CAITLIN CLARK (PHARMD)
Entity Type:Individual
Prefix:
First Name:CAITLIN
Middle Name:CLARK
Last Name:YESETA
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10239 RUSSETT AVE
Mailing Address - Street 2:
Mailing Address - City:SUNLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91040-1823
Mailing Address - Country:US
Mailing Address - Phone:818-259-2325
Mailing Address - Fax:
Practice Address - Street 1:10239 RUSSETT AVE
Practice Address - Street 2:
Practice Address - City:SUNLAND
Practice Address - State:CA
Practice Address - Zip Code:91040-1823
Practice Address - Country:US
Practice Address - Phone:818-259-2325
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-08
Last Update Date:2021-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAINT31227390200000X
FLPSI28442390200000X
CA73773183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program