Provider Demographics
NPI:1083039358
Name:CALVILLO, ANNA
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:CALVILLO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:176 LINDE CIR
Mailing Address - Street 2:
Mailing Address - City:MARINA
Mailing Address - State:CA
Mailing Address - Zip Code:93933-2205
Mailing Address - Country:US
Mailing Address - Phone:831-316-2729
Mailing Address - Fax:
Practice Address - Street 1:176 LINDE CIR
Practice Address - Street 2:
Practice Address - City:MARINA
Practice Address - State:CA
Practice Address - Zip Code:93933-2205
Practice Address - Country:US
Practice Address - Phone:831-316-2729
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-24
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ92069ZOtherIN SANTA CRUZ COUNTY MEDICARE GROUP PTAN#