Provider Demographics
NPI:1063453579
Name:CALIVA, RAMONA L (DPM)
Entity Type:Individual
Prefix:DR
First Name:RAMONA
Middle Name:L
Last Name:CALIVA
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:710 LEBO BLVD
Mailing Address - Street 2:
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98310-3325
Mailing Address - Country:US
Mailing Address - Phone:360-373-1772
Mailing Address - Fax:360-377-7151
Practice Address - Street 1:710 LEBO BLVD
Practice Address - Street 2:
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98310-3325
Practice Address - Country:US
Practice Address - Phone:360-373-1772
Practice Address - Fax:360-377-7151
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-08
Last Update Date:2016-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAP 000000392213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1023910Medicaid
CA0650OtherREGENCES RIDER
WA480006194OtherMEDICARE RAILROAD
0006950OtherL&I
G8861890Medicare PIN
WA480006194OtherMEDICARE RAILROAD
CA0650OtherREGENCES RIDER