Healthcare Provider Details

I. General information

NPI: 1982181319
Provider Name (Legal Business Name): ABBY GAYLE CALUAG COMES PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2018
Last Update Date: 02/18/2020
Certification Date: 02/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 CONGRESS ST STE 103
PASADENA CA
91105-3027
US

IV. Provider business mailing address

1346 N COLUMBUS AVE APT 7
GLENDALE CA
91202-1645
US

V. Phone/Fax

Practice location:
  • Phone: 626-796-6164
  • Fax:
Mailing address:
  • Phone: 323-493-1835
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA55802
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: