Healthcare Provider Details

I. General information

NPI: 1588383640
Provider Name (Legal Business Name): CARLOS DAVID CALVILLO FNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2022
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

909 E APACHE BLVD
TEMPE AZ
85281-5817
US

IV. Provider business mailing address

909 E APACHE BLVD
TEMPE AZ
85281-5817
US

V. Phone/Fax

Practice location:
  • Phone: 866-389-2727
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2022026066
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: