Healthcare Provider Details

I. General information

NPI: 1962698985
Provider Name (Legal Business Name): STANLEY CALDERWOOD, M.D., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2007
Last Update Date: 01/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 ATLANTIC AVE
LONG BEACH CA
90806-1701
US

IV. Provider business mailing address

455 S MAIN ST PSF MANAGEMENT SERVICES
ORANGE CA
92868-3835
US

V. Phone/Fax

Practice location:
  • Phone: 562-933-8007
  • Fax: 562-933-8606
Mailing address:
  • Phone: 714-532-8649
  • Fax: 714-532-8374

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License NumberA73264
License Number StateCA

VIII. Authorized Official

Name: MR. STANLEY CALDERWOOD
Title or Position: PRESIDENT
Credential: M.D.
Phone: 714-289-4511