Healthcare Provider Details

I. General information

NPI: 1083347702
Provider Name (Legal Business Name): CAL-X FAMILY CLINIC PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2022
Last Update Date: 11/09/2022
Certification Date: 11/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

955 N MCQUEEN RD STE 2
CHANDLER AZ
85225-8129
US

IV. Provider business mailing address

955 N MCQUEEN RD STE 2
CHANDLER AZ
85225-8129
US

V. Phone/Fax

Practice location:
  • Phone: 602-617-9774
  • Fax:
Mailing address:
  • Phone: 602-617-9774
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. TEKOYA MOSELINE CALIXTE
Title or Position: MEMBER
Credential: FNP
Phone: 602-617-9774