Provider Demographics
NPI:1871310409
Name:GLADYSZ, CAITLYN (PA-C)
Entity type:Individual
Prefix:
First Name:CAITLYN
Middle Name:
Last Name:GLADYSZ
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 1:12488 CENTRAL AVE STE B
Mailing Address - Street 2:
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91710-2625
Mailing Address - Country:US
Mailing Address - Phone:909-613-0100
Mailing Address - Fax:
Practice Address - Street 1:12488 CENTRAL AVE STE B
Practice Address - Street 2:
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710-2625
Practice Address - Country:US
Practice Address - Phone:909-613-0100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-24
Last Update Date:2024-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant