Provider Demographics
NPI:1487075008
Name:DAMMIN, CAITLIN N (PA-C)
Entity type:Individual
Prefix:
First Name:CAITLIN
Middle Name:N
Last Name:DAMMIN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57463 29 PALMS HWY STE 201
Mailing Address - Street 2:
Mailing Address - City:YUCCA VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92284-2925
Mailing Address - Country:US
Mailing Address - Phone:760-365-7546
Mailing Address - Fax:
Practice Address - Street 1:57463 29 PALMS HWY STE 201
Practice Address - Street 2:
Practice Address - City:YUCCA VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92284-2925
Practice Address - Country:US
Practice Address - Phone:760-365-7546
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-27
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA61073363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
1487075008OtherNPI