Provider Demographics
NPI:1790357556
Name:CALDERONE, KAITLIN
Entity type:Individual
Prefix:
First Name:KAITLIN
Middle Name:
Last Name:CALDERONE
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 1:10138 PALMS BLVD APT 13
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90034-3828
Mailing Address - Country:US
Mailing Address - Phone:818-461-2697
Mailing Address - Fax:
Practice Address - Street 1:18663 VENTURA BLVD STE 202
Practice Address - Street 2:
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-4151
Practice Address - Country:US
Practice Address - Phone:818-600-1005
Practice Address - Fax:855-570-0747
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-12
Last Update Date:2024-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86144290133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered