Basic Information
| Provider Information | |||||||||
| NPI: | 1871518977 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CALLISTER | ||||||||
| FirstName: | CYRIL | ||||||||
| MiddleName: | BRUCE | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 350 30TH ST | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | OAKLAND | ||||||||
| State: | CA | ||||||||
| PostalCode: | 946093424 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5102048290 | ||||||||
| FaxNumber: | 5102738977 | ||||||||
| Practice Location | |||||||||
| Address1: | 350 30TH ST | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | OAKLAND | ||||||||
| State: | CA | ||||||||
| PostalCode: | 946093424 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5102048290 | ||||||||
| FaxNumber: | 5102738977 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/12/2006 | ||||||||
| LastUpdateDate: | 09/29/2011 | ||||||||
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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 | 363AM0700X | PA20991 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No ID Information.