Provider Demographics
NPI:1356887152
Name:CAUDILLO, ERICA ROXANNE (CDAAC)
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:ROXANNE
Last Name:CAUDILLO
Suffix:
Gender:F
Credentials:CDAAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:167 N 3RD AVE STE N
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-6052
Mailing Address - Country:US
Mailing Address - Phone:909-331-8820
Mailing Address - Fax:
Practice Address - Street 1:167 N 3RD AVE STE N
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-6052
Practice Address - Country:US
Practice Address - Phone:909-331-8820
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-17
Last Update Date:2017-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)