Provider Demographics
NPI:1508674532
Name:CAILIPAN-GORDO, JAEDEN
Entity type:Individual
Prefix:
First Name:JAEDEN
Middle Name:
Last Name:CAILIPAN-GORDO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5920 FENNEL WAY
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93309-5568
Mailing Address - Country:US
Mailing Address - Phone:626-701-6766
Mailing Address - Fax:
Practice Address - Street 1:5920 FENNEL WAY
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93309-5568
Practice Address - Country:US
Practice Address - Phone:626-701-6766
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-23
Last Update Date:2024-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant