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NPI Code Detail

MEDICARE: MR. CALVIN WHEELER PRATHER LCSW

MEDICARE: MR. CALVIN WHEELER PRATHER LCSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social WorkerLCS10519CA

General Provider Information

NPI Number : 1629185145
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. CALVIN WHEELER PRATHER LCSW
Provider Business Mailing Address
First Line : 3511 CAMINO DEL RIO SOUTH
Second Line : SUITE 500
City : SAN DIEGO
State : CA
Zip : 92108-4022
Country : US
Telephone Number : 619-282-4600
Fax Number : 619-624-0178
Provider Business Practice Location Address
First Line : 3511 CAMINO DEL RIO SOUTH
Second Line : SUITE 500
City : SAN DIEGO
State : CA
Zip : 92108-4022
Country : US
Telephone Number : 619-282-4600
Fax Number : 619-624-0178
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/23/2006
Last Update Date : 08/06/2010

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