Basic Information
| Provider Information | |||||||||
| NPI: | 1265550677 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CALUYA | ||||||||
| FirstName: | MARISSA | ||||||||
| MiddleName: | TAGABAN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 400 N PEPPER AVE | ||||||||
| Address2: | PEDIATRICS ADMINISTRATION | ||||||||
| City: | COLTON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 923241819 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8554228029 | ||||||||
| FaxNumber: | 9095801438 | ||||||||
| Practice Location | |||||||||
| Address1: | 400 N PEPPER AVE | ||||||||
| Address2: | PEDIATRICS ADMINISTRATION | ||||||||
| City: | COLTON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 923241819 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8554228029 | ||||||||
| FaxNumber: | 9095801438 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/26/2007 | ||||||||
| LastUpdateDate: | 12/22/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | C51278 | CA | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.