Most Relevant Information
Provider Data
| NPI Number: | 1003567645 |
| Provider Name: | KAITLIN ELIZABETH BACK NCSC |
| Entity Type: | Individual |
| Taxonomy Code: | 171M00000X |
| Specialty: | Case Manager/Care Coordinator |
| License Number: |
Most Important Dates
| Enumeration Date: | 01/14/2022 |
| Last Updated: | 01/14/2022 |
Provider Practice Location
5284 ADOLFO RD STE 100
CAMARILLO
CA
930126790
Practice Location Phone/Fax
| Phone: | 8052890120 |
| Fax: | 8052890130 |
Provider Mailing Location
5284 ADOLFO RD STE 100
CAMARILLO
CA
930126790
Provider Mailing Phone/Fax
| Phone: | 8052890120 |
| Fax: | 8052890130 |