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General NPI Number Information
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NPI Number | 1790201796
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Entity Type | Individual
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Provider Name | JESSICA M CALLES ATC
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Gender | Female
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Dates
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Enumeration Date | 08/21/2017
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Last Update Date | 02/19/2021
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Provider Practice Location Address
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Address Line | 12806 FAIRWAY RD
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City | VICTORVILLE
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State | CA
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Zip | 92392
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Country | US
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Telephone | 626-488-5650
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Fax |
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Provider Business Mailing Address
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Address Line | 7519 SVL BOX
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City | VICTORVILLE
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State | CA
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Zip | 92395-5157
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 2000030101
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License Number State | CA
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