Provider Demographics
NPI:1427492875
Name:MCCAULEY, MARTIN SEAN (LPN/LVN)
Entity type:Individual
Prefix:MR
First Name:MARTIN
Middle Name:SEAN
Last Name:MCCAULEY
Suffix:
Gender:M
Credentials:LPN/LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5101
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92263-5101
Mailing Address - Country:US
Mailing Address - Phone:760-799-1919
Mailing Address - Fax:
Practice Address - Street 1:74100 RUTLEDGE WAY
Practice Address - Street 2:
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92260-2644
Practice Address - Country:US
Practice Address - Phone:760-799-1919
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-28
Last Update Date:2013-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN271806164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse