MEDICARE: CALVIN SPIVEY HHP

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
1	225700000X	Massage Therapist	58460	CA

General Provider Information

NPI Number	:	1720467855
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CALVIN SPIVEY HHP

Provider Business Mailing Address
First Line	:	4118 CALGARY AVE
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92122-2509
Country	:	US
Telephone Number	:	619-719-1644
Fax Number	:

Provider Business Practice Location Address
First Line	:	2180 GARNET AVE
Second Line	:	SUITE 3L
City	:	SAN DIEGO
State	:	CA
Zip	:	92109-3610
Country	:	US
Telephone Number	:	619-719-1644
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/21/2015
Last Update Date	:	05/21/2015

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