Healthcare Provider Details

I. General information

NPI: 1629395637
Provider Name (Legal Business Name): LOREN CALLUM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/29/2010
Last Update Date: 04/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9864 BALDWIN PL
EL MONTE CA
91731-2202
US

IV. Provider business mailing address

811 NEW YORK DR
ALTADENA CA
91001-3021
US

V. Phone/Fax

Practice location:
  • Phone: 626-433-1311
  • Fax:
Mailing address:
  • Phone: 626-794-9846
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: