Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | A128054 | CA |
NPI | 1003182544 |
---|---|
Provider Name | Caitlin Thu Chau |
First Address | Moreno Valley, CA 92553-3116 |
Second Address | Moreno Valley, CA 92553-3116 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/03/2012 |
Last Update Date | 08/12/2021 |