MEDICARE: WALTER REED CALLEN

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	164X00000X	Licensed Vocational Nurse	735367	CA
2	175T00000X	Peer Specialist	164X000000X

General Provider Information

NPI Number	:	1972451854
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WALTER REED CALLEN

Provider Business Mailing Address
First Line	:	9410 MACARTHUR BLVD APT 301
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94605-4738
Country	:	US
Telephone Number	:	510-372-7464
Fax Number	:

Provider Business Practice Location Address
First Line	:	9410 MACARTHUR BLVD APT 301
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94605-4738
Country	:	US
Telephone Number	:	510-372-7464
Fax Number	:

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

Provider Enumeration Date	:	03/17/2026
Last Update Date	:	03/17/2026

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Directions to “ WALTER REED CALLEN ” Practice Location

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