Provider Demographics
NPI:1265100853
Name:O'MALLEY, CAITLIN (PA)
Entity type:Individual
Prefix:
First Name:CAITLIN
Middle Name:
Last Name:O'MALLEY
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5406 QUANE RD
Mailing Address - Street 2:
Mailing Address - City:ROCKLIN
Mailing Address - State:CA
Mailing Address - Zip Code:95765-5136
Mailing Address - Country:US
Mailing Address - Phone:415-827-4146
Mailing Address - Fax:
Practice Address - Street 1:5406 QUANE RD
Practice Address - Street 2:
Practice Address - City:ROCKLIN
Practice Address - State:CA
Practice Address - Zip Code:95765-5136
Practice Address - Country:US
Practice Address - Phone:415-827-4146
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-31
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant