Provider Demographics
NPI:1053994582
Name:SKYWEST MEDICAL
Entity type:Organization
Organization Name:SKYWEST MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:
Authorized Official - Last Name:CALDRON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-923-8812
Mailing Address - Street 1:9420 RESEDA BLVD # 503
Mailing Address - Street 2:
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91324-2932
Mailing Address - Country:US
Mailing Address - Phone:818-581-8396
Mailing Address - Fax:
Practice Address - Street 1:9420 RESEDA BLVD # 503
Practice Address - Street 2:
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91324-2932
Practice Address - Country:US
Practice Address - Phone:818-581-8396
Practice Address - Fax:818-280-6499
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-03
Last Update Date:2021-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0208XAmbulatory Health Care FacilitiesClinic/CenterRadiology, Mobile