1700822251 NPI number — RAMONA L. CALIVA DPM

Table of content: (NPI 1700822251)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700822251 NPI number — RAMONA L. CALIVA DPM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RAMONA L. CALIVA DPM
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1700822251
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/22/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1211 IVY RD
Provider Second Line Business Mailing Address:
STE 100
Provider Business Mailing Address City Name:
BREMERTON
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98310-3511
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-373-1772
Provider Business Mailing Address Fax Number:
360-377-7151

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1211 IVY RD
Provider Second Line Business Practice Location Address:
STE 100
Provider Business Practice Location Address City Name:
BREMERTON
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98310-3511
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-373-1772
Provider Business Practice Location Address Fax Number:
360-377-7151
Provider Enumeration Date:
06/22/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CALIVA
Authorized Official First Name:
RAMONA
Authorized Official Middle Name:
L
Authorized Official Title or Position:
OWNER/PODIATRIST
Authorized Official Telephone Number:
360-373-1772

Provider Taxonomy Codes

  • Taxonomy code: 213E00000X , with the licence number:  P 392 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 480006194 . This is a "MEDICARE RAILROAD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1023910 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0006950 . This is a "L&I" identifier . This identifiers is of the category "OTHER".
  • Identifier: CA0650 . This is a "REGENCE RIDER" identifier . This identifiers is of the category "OTHER".




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