Basic Information
| Provider Information | |||||||||
| NPI: | 1316985435 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CALVILLO | ||||||||
| FirstName: | RUBEN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 655 E RIVER RD | ||||||||
| Address2: | |||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857045840 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5206942700 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1141 S LA CANADA DR | ||||||||
| Address2: | |||||||||
| City: | GREEN VALLEY | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 856141945 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5206943030 | ||||||||
| FaxNumber: | 5206943055 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/02/2006 | ||||||||
| LastUpdateDate: | 10/15/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 14238 | AZ | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 231564 | 05 | AZ | MEDICAID |