Healthcare Provider Details

I. General information

NPI: 1073944112
Provider Name (Legal Business Name): MARIANNE CALVANESE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/27/2013
Last Update Date: 12/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2003 S LAMAR BLVD STE 12
AUSTIN TX
78704-3368
US

IV. Provider business mailing address

2003 S LAMAR BLVD STE 12
AUSTIN TX
78704-3368
US

V. Phone/Fax

Practice location:
  • Phone: 512-586-6834
  • Fax: 888-835-8944
Mailing address:
  • Phone: 512-586-6834
  • Fax: 888-835-8944

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number90-0408
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: