MEDICARE: VICTORIA CALLAHAN PA-C

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
1	363A00000X	Physician Assistant	57591	CA

General Provider Information

NPI Number	:	1568937126
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VICTORIA CALLAHAN PA-C

Provider Business Mailing Address
First Line	:	1950 SUNNY CREST DR STE 2300
Second Line	:
City	:	FULLERTON
State	:	CA
Zip	:	92835-3644
Country	:	US
Telephone Number	:	714-446-5180
Fax Number	:

Provider Business Practice Location Address
First Line	:	1950 SUNNY CREST DR STE 2300
Second Line	:
City	:	FULLERTON
State	:	CA
Zip	:	92835-3644
Country	:	US
Telephone Number	:	714-446-5180
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/10/2018
Last Update Date	:	03/07/2023

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