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NPI Code Detail

MEDICARE: JENELLE CHRISTINE CALLIES BA

MEDICARE: JENELLE CHRISTINE CALLIES BA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1174400000XSpecialist

General Provider Information

NPI Number : 1225110877
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENELLE CHRISTINE CALLIES BA
Provider Business Mailing Address
First Line : 8954 TAURUS PL
Second Line :
City : SAN DIEGO
State : CA
Zip : 92126-1939
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3211 JEFFERSON ST
Second Line :
City : SAN DIEGO
State : CA
Zip : 92110-4424
Country : US
Telephone Number : 619-682-4012
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/20/2006
Last Update Date : 07/08/2007

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Directions to “ JENELLE CHRISTINE CALLIES BA” Practice Location

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