Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | G53322 | CA |
NPI | 1467489492 |
---|---|
Provider Name | James Thompson Caillouette |
First Address | Newport Beach, CA 92660-7901 |
Second Address | Newport Beach, CA 92660-7901 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/06/2006 |
Last Update Date | 17/02/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E52005 | (02) | CA |
GU303Z | (02) | CA |