Healthcare Provider Details

I. General information

NPI: 1447285333
Provider Name (Legal Business Name): ROBERT CY MCCALLISTER LAC.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8680 GREENBACK LN SUITE 110
ORANGEVALE CA
95662-3969
US

IV. Provider business mailing address

8680 GREENBACK LN SUITE 110
ORANGEVALE CA
95662-3969
US

V. Phone/Fax

Practice location:
  • Phone: 916-988-3379
  • Fax: 916-988-3324
Mailing address:
  • Phone: 916-988-3379
  • Fax: 916-988-3324

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number10242
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: