Healthcare Provider Details

I. General information

NPI: 1497145718
Provider Name (Legal Business Name): CALYX PERFORMANCE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2015
Last Update Date: 01/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1038 CHELSEA AVE
SANTA MONICA CA
90403-4612
US

IV. Provider business mailing address

1038 CHELSEA AVE
SANTA MONICA CA
90403-4612
US

V. Phone/Fax

Practice location:
  • Phone: 424-248-7701
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State

VIII. Authorized Official

Name: JASON PRALL
Title or Position: CEO
Credential:
Phone: 206-914-8548