Healthcare Provider Details

I. General information

NPI: 1780853341
Provider Name (Legal Business Name): TERI L. CALHOUN PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2008
Last Update Date: 10/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1140 ABBOTT ST
SALINAS CA
93901-4503
US

IV. Provider business mailing address

319 N CHURCH ST
VISALIA CA
93291-5008
US

V. Phone/Fax

Practice location:
  • Phone: 831-422-2188
  • Fax:
Mailing address:
  • Phone: 855-733-7772
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberPA14602
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA05575
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA05575
License Number StateTX
# 4
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA14602
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: