Provider Demographics
NPI:1487160537
Name:DIOS, CAITLIN NICOLE (ATC)
Entity type:Individual
Prefix:
First Name:CAITLIN
Middle Name:NICOLE
Last Name:DIOS
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1156 HIGH STREET
Mailing Address - Street 2:UC SANTA CRUZ - EAST FIELD HOUSE - OPERS
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95064-1077
Mailing Address - Country:US
Mailing Address - Phone:831-459-4793
Mailing Address - Fax:831-459-4070
Practice Address - Street 1:1156 HIGH STREET
Practice Address - Street 2:UC SANTA CRUZ - EAST FIELD HOUSE - OPERS
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95064-1077
Practice Address - Country:US
Practice Address - Phone:831-459-4793
Practice Address - Fax:831-459-4070
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-26
Last Update Date:2017-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic TrainerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
2000024579OtherBOARD OF CERTIFICATION