Healthcare Provider Details

I. General information

NPI: 1922458298
Provider Name (Legal Business Name): ROBERT T. CALVERT D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: ROBBIE CALVERT

II. Dates (important events)

Enumeration Date: 06/17/2016
Last Update Date: 08/18/2025
Certification Date: 08/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4058 WILLOWS RD
ALPINE CA
91901-1668
US

IV. Provider business mailing address

4058 WILLOWS RD
ALPINE CA
91901-1668
US

V. Phone/Fax

Practice location:
  • Phone: 619-445-1188
  • Fax:
Mailing address:
  • Phone: 619-445-1188
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number12488444-1204
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number20A23529
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: