MEDICARE: DR. JOAN MARIE CALANDRA PHD

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	103T00000X	Psychologist	PSY18529	CA

General Provider Information

NPI Number	:	1730173865
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOAN MARIE CALANDRA PHD

Provider Business Mailing Address
First Line	:	11340 W OLYMPIC BLVD
Second Line	:	SUITE 150
City	:	LOS ANGELES
State	:	CA
Zip	:	90064-1608
Country	:	US
Telephone Number	:	310-433-7723
Fax Number	:	310-207-2506

Provider Business Practice Location Address
First Line	:	11340 W OLYMPIC BLVD
Second Line	:	SUITE 150
City	:	LOS ANGELES
State	:	CA
Zip	:	90064-1608
Country	:	US
Telephone Number	:	310-243-5343
Fax Number	:	310-836-9920

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

Provider Enumeration Date	:	09/05/2005
Last Update Date	:	02/10/2014

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