Healthcare Provider Details

I. General information

NPI: 1649857244
Provider Name (Legal Business Name): CALVIN ORUTSAHAKIJ SONGVEERA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2021
Last Update Date: 03/28/2021
Certification Date: 03/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3430 E LA PALMA AVE
ANAHEIM CA
92806-2020
US

IV. Provider business mailing address

27317 CHESTERFIELD DR
VALENCIA CA
91354-2147
US

V. Phone/Fax

Practice location:
  • Phone: 714-644-7180
  • Fax:
Mailing address:
  • Phone: 661-373-5104
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number84278
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: