=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043418106
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | RENATO C CALIP DMD
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/10/2007
-----------------------------------------------------
Last Update Date | 06/25/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2386 JUNIPERO SERRA BLVD
-----------------------------------------------------
City | DALY CITY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94015-1647
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 650-994-3836
-----------------------------------------------------
Fax | 650-994-0612
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2386 JUNIPERO SERRA BLVD
-----------------------------------------------------
City | DALY CITY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94015-1647
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 650-994-3836
-----------------------------------------------------
Fax | 650-994-0612
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. RENATO CABASAAN CALIP
-----------------------------------------------------
Credential | DMD
-----------------------------------------------------
Telephone | 650-994-3836
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 037087
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------